The Na+-excreting efficacy of indapamide in combination with furosemide in massive edema

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Abstract
Massive systemic edema is often observed in patients with severe nephrotic syndrome, including diabetic nephropathy. Although furosemide, a loop diuretic, is often administered to these patients, some patients do not respond to this treatment, still showing massive edema. The efficacy of indapamide which has a thiazide-like effect on distal convoluted tubules in combination with furosemide, was evaluated in eight patients with massive edema, in regard to both Na+ excretion and diuresis. Indapamide 2 mg was administered once a day, in the morning, to patients in whom it was considered that furosemide treatment of 40–120 mg a day for 1 week was ineffective. Urinary Na+ excretion was markedly increased, from 83.7 ± 82.2 mEq/day to 140.7 ± 33.8 mEq/day after 1 week of the combination therapy compared with furosemide alone (P < 0.01); urine volume was also increased, from 1070 ± 230 ml to 1359 ± 296 ml after 1 week of the combination therapy (P < 0.05). In this context, body weight was significantly decreased, from 57.2 ± 12.3 kg to 53.4 ± 12.8 kg, after the combination therapy (P = 0.01). Indapamide in combination with furosemide was well tolerated, and no significant changes in serum levels of creatinine and potassium were observed. This combination therapy appears to be effective in patients with massive edema, as it increased diuresis, and achieved potent Na+ excretion.