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Liaqat R, Rasool F, Noreen S, Rai N, Naseem A, Shoaib MH, Mahmood H, Ashraf MA. Fabrication, characterization, and docking studies of furosemide-loaded nanosponges using the emulsion solvent diffusion method. Nanomedicine (Lond) 2025:1-13. [PMID: 40329918 DOI: 10.1080/17435889.2025.2501518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 04/30/2025] [Indexed: 05/08/2025] Open
Abstract
AIMS This study aimed to fabricate, characterize, and perform molecular docking of furosemide-loaded nanosponges (NSs) using the emulsion solvent diffusion method. MATERIAL AND METHODS Sustained-release NS formulations of furosemide were developed using ethylcellulose, polyvinyl alcohol (PVA), and dichloromethane (DCM) via the emulsion solvent diffusion technique. The formulations were evaluated for production yield, actual drug content, entrapment efficiency, drug-polymer compatibility, surface morphology, docking study, and in vitro drug release. RESULTS SEM images displayed the nanosized, spherical, porous, and spongy texture of furosemide NS. Fourier-transform infrared spectroscopy (FTIR) spectra showed no drug-polymer incompatibility. Powder X-ray diffraction (PXRD) analysis indicated an amorphous state of furosemide, while differential scanning calorimetry (DSC) suggested drug-polymer complexation. In vitro studies demonstrated sustained drug release for up to 10 h. Molecular docking supported stable interactions between furosemide and polymers. Molecular dynamics (MD) simulations further revealed adequate hydrogen bonding and diffusion behavior, confirming polymer composition-dependent release and structural stability. CONCLUSION These findings indicate that furosemide-loaded NSs are a promising sustained-release delivery system capable of reducing dosing frequency and enhancing patient compliance.
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Affiliation(s)
- Rabia Liaqat
- Department of Pharmaceutics, Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Fatima Rasool
- Department of Pharmaceutics, Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sobia Noreen
- Department of Pharmaceutics, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
- Centre for Chemistry and Biomedicine, Department of Pharmaceutical Technology, Institute of Pharmacy, University of Innsbruck, Innsbruck, Austria
| | - Nadia Rai
- Department of Pharmaceutics, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Ayesha Naseem
- Department of Pharmaceutics, Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Hassan Mahmood
- Humanities Department, COMSATS University Islamabad, Lahore Campus, Punjab, Pakistan
| | - Muhammad Azeem Ashraf
- Department of Supply Chain, University of Management and Technology Lahore, Lahore, Pakistan
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Zhang K, Zhang H, Zhao C, Hu Z, Shang J, Chen Y, Huo Y, Zhao C, Li B, Guo S. The furosemide stress test predicts the timing of continuous renal replacement therapy initiation in critically ill patients with acute kidney injury: a double-blind prospective intervention cohort study. Eur J Med Res 2023; 28:149. [PMID: 37020287 PMCID: PMC10074797 DOI: 10.1186/s40001-023-01092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/07/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Continuous renal replacement therapy (CRRT) remains a crucial treatment for critically ill patients with acute kidney injury (AKI), although the timing of its initiation is still a matter of contention. Furosemide stress testing (FST) may be a practical and beneficial prediction instrument. This research was meant to examine if FST can be used to identify high-risk patients for CRRT. METHODS This study is a double-blind, prospective interventional cohort study. For patients with AKI receiving intensive care unit (ICU) income, FST was selected with furosemide 1 mg/kg intravenous (1.5 mg/kg intravenous if a loop diuretic was received within 7 days). Urinary volume more than 200 ml at 2 h after FST was FST-responsive, less than 200 ml was FST-nonresponsive. The FST results are kept strictly confidential from the clinician, who decides whether to initiate CRRT based on laboratory testing and clinical symptoms other than the FST data. The FST data are concealed from both the patients and the clinician. RESULTS FST was delivered to 187 of 241 patients who satisfied the inclusion and exclusion criteria, with 48 patients responding to the test and 139 patients not responding. 18/48 (37.5%) of the FST-responsive patients received CRRT, while 124/139 (89.2%) of the FST-nonresponsive patients received CRRT. There was no significant difference between the CRRT and non-CRRT groups in terms of general health and medical history (P > 0.05). Urine volume after 2 h of FST was considerably lower in the CRRT group than in the non-CRRT group (35 ml, IQR5-143.75 versus 400 ml, IQR210-890; P = 0.000). FST non-responders were 2.379 times more likely to initiate CRRT than FST responders (95% CI 1.644-3.443, P = 0.000). The area under the curve (AUC) for initiating CRRT was 0.966 (cutoff of 156 ml, sensitivity of 94.85%, specificity of 98.04%, P < 0.001). CONCLUSION This study demonstrated that FST is a safe and practical approach for predicting the initiation of CRRT in critically ill AKI patients. Trial registration www.chictr.org.cn , ChiCTR1800015734, Registered 17 April 2018.
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Affiliation(s)
- Kun Zhang
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Haohua Zhang
- Department of Emergency, Xian People's Hospital, Xian, Shanxi, China
| | - Chai Zhao
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhenjie Hu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiuyan Shang
- Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuhong Chen
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yan Huo
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Congcong Zhao
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Li
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Suzhi Guo
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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Côté JM, Bouchard J, Murray PT, Beaubien-Souligny W. Diuretic strategies in patients with resistance to loop-diuretics in the intensive care unit: A retrospective study from the MIMIC-III database. J Crit Care 2021; 65:282-291. [PMID: 34298494 DOI: 10.1016/j.jcrc.2021.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate various diuretic strategies to alleviate loop-diuretics resistance in critically ill patients. MATERIALS AND METHOD ICU adults requiring more than 1 mg/kg/day of furosemide, from the MIMIC-III database. Four diuretic strategies were investigated: incremental dose of loop diuretics, continuous infusion, combinations with a second class of diuretics and administration of intravenous albumin. A generalized estimating equation was used to investigate the associations between these strategies and endpoints. The primary outcome was the 24-h urine output and secondary endpoints included fluid balance, weight change, electrolyte and acid-base abnormalities, kidney replacement therapy initiation, and mortality. RESULTS A total of 7645 ICU stays from 6358 patients were included. After adjustment, the use of continuous loop-diuretic infusion was associated with a higher 24-h urine output (β: 732, 95% CI:669-795, p < 0.001), lower 24-h fluid balance (p < 0.001) and greater weight loss at 48-h (p < 0.001). Thiazide- and carbonic anhydrase inhibitor combinations were both associated with higher urine output (p < 0.001) and weight loss at 48-h (p < 0.01), while intravenous albumin was associated with fluid gain (p < 0.001). Risks of electrolyte and metabolic disturbances varied across diuretic strategies. CONCLUSIONS Continuous loop-diuretic infusion and thiazide- or acetazolamide-loop diuretic combinations increased urine output significantly, leading to a negative fluid balance and weight loss.
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Affiliation(s)
- Jean-Maxime Côté
- Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada; Clinical Research Centre, University College Dublin, Ireland.
| | - Josée Bouchard
- Division of Nephrology, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada
| | - Patrick T Murray
- Clinical Research Centre, University College Dublin, Ireland; School of medicine, Division of Nephrology, Mater Misericordiae University Hospital, Ireland
| | - William Beaubien-Souligny
- Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada
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Mariano F, Mella A, Vincenti M, Biancone L. Furosemide as a functional marker of acute kidney injury in ICU patients: a new role for an old drug. J Nephrol 2019; 32:883-893. [PMID: 31090022 DOI: 10.1007/s40620-019-00614-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
Abstract
New pharmacokinetics insight suggests that the furosemide pharmacology occurring in ICU patients with AKI is similar, but not equal to that described in chronic stable renal patients. Even if the diuretic response to furosemide is expressed by a steep dose-response curve positively correlated with renal function, pharmacodynamic limitations occur when creatinine clearance is < 20 ml/min or urine output is < 500 ml/12 h. In such cases, other factors specifically due to acute tubular injury can interfere with the furosemide-induced diuretic output. As modality of administration recent reports and metanalysis, even if not conclusive, suggest that for the same given dose a continuous infusion of furosemide was superior in diuretic response. For septic shock patients on CVVHDF where treatment adds an additional clearance of furosemide the maximum diuretic response is achieved by a continuous infusion of 20 mg/h of furosemide. At this infusion rate the reached plasma level was < 20 mg/L, a range considered safe and not ototoxic. Therefore, the severity of AKI establishes whether a patient will respond to furosemide. In this review we summarized all these recent updates, also suggesting that the diuretic response under continuous infusion may allow assessing glomerular and tubular functions with increased reliability than a bolus dose. However, validation studies are still needed to support continuous infusion as a stress test.
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Affiliation(s)
- Filippo Mariano
- Nephrology, Dialysis and Transplantation U, Department of Medical Sciences, CTO Hospital, University of Turin, City of Health and Science, Via G. Zuretti 29, 10126, Turin, Italy.
| | - Alberto Mella
- Nephrology, Dialysis and Transplantation U, Department of Medical Sciences, CTO Hospital, University of Turin, City of Health and Science, Via G. Zuretti 29, 10126, Turin, Italy
| | - Marco Vincenti
- Department of Chemistry, University of Turin, Turin, Italy
| | - Luigi Biancone
- Nephrology, Dialysis and Transplantation U, Department of Medical Sciences, CTO Hospital, University of Turin, City of Health and Science, Via G. Zuretti 29, 10126, Turin, Italy
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