Effects, both acute and after repeated dosing of 200 mg of intravenous
torasemide in comparison to baseline values on placebo, were investigated with respect to 24 h fractional volume excretion and
electrolyte excretion, signs of peripheral
edema and changes in
body weight in the present open uncontrolled multicenter study. Fourty-four patients with advanced
chronic renal failure (mean
creatinine clearance 8.9 +/- 9.6 ml/min, range 1.1-63.7 ml/min) were enrolled after they had given their informed consent. The increase vs placebo in the primary efficacy variable 24 h fractional volume excretion was statistically significant both acutely (p = 0.0001) and after repeated daily
injections (p = 0.0012). The acute changes of the means of fractional volume excretion (from 14.32% to 21.07%) and of absolute 24 h urinary volume (from 1303 ml to 2124 ml) were as expected from earlier data. In addition to the acute results our study showed that after seven days of daily
injections there was still a considerable
diuretic effect (mean fractional volume excretion: 18.10%, absolute 24 h urinary volume: 1664 ml). Our data support earlier results in that the change in fractional
potassium excretion was considerably smaller than that of
sodium of
chloride excretion. However, this effect which was more pronounced after acute administration of
torasemide seems to vanish after repeated dosing. After repeated dosing there was only a minor change in
calcium excretion and there was no alteration in
phosphate excretion, neither acutely nor with repeated dosing. Along with the enhanced diuresis there was a relevant reduction in
body weight and a clinical significant improvement preexisting signs of peripheral
edema.
Torasemide was found to be also efficacious in patients on
hemodialysis (with residual diuresis of > or = 300 ml): after the first i.v. dose of 200 mg
torasemide the mean fractional volume excretion was increased from 16.22% at baseline by 3.42% to 18.99% (in absolute 24 h urinary volume from 1044 ml at baseline by 563 ml to 1607 ml). In parallel, the mean fractional
sodium excretion was increased from 8.67% at baseline by 2.99% to 11.14% (in absolute 24 h urinary
sodium excretion from 83.3 mmol at baseline by 51.2 mmol to 128.0 mmol). There was no serious adverse events related to the administration of
torasemide.
Torasemide appears to be a good choice for the treatment of patients with
renal failure.