Article appraisal

By Jean Pierre Fakhoury

Course Instructor : Dr. Soha Sinno

 OVERVIEW
• Glucocorticoids have been proven to have potent diuretic effects in animal
studies.
• Prednisone can rapidly eliminate volume overload and improve clinical
status and renal function in CHF with diuretic resistance.
• Glucocorticoids regulates the synthesis and release of ANP.
• Aim of the study :
Was designed to determine the clinical efficacy of chronic administration of
prednisone in the management of patients with diuretic resistance.
 Study design
• Open label non-controlled prospective study. (is a type of clinical trial in
which both the researchers and participants know which treatment is
being administered)
 Blinding
• No blinding.
 Type of assignment used
• All patients received same treatment.

• Prednisone (1mg/kg daily with a maximum dose of 60mg/day) was

administered for 4 weeks.

• Spironolactone ranging from 60mg/day to 180mg/day (mean 100mg/day)

• Number enrolled per group: 13 CHF patients with diuretic resistance.

 Assessment
• Daily:
• Body weight
• Supine and seated BP
• Pulse rate
• Jugular venous distention
• Edematous status
 Inclusion and Exclusion criteria
• Inclusion criteria : severe CHF with significant volume overload and
diuretic resistance refractory to sequential nephron blockade.

• Exclusion criteria : patient refusal , signs of infections , chronic renal

failure , pericardial diseases , prerenal azotemia , hypovolemia, renal
disease.
 Results
• After prednisone was added:
• Urine volume began to increase
• Diuresis established 3 to 4 days after initiating the therapy
• Effect persisted during treatment
• Body weight reduction (3-9 kg)
• Dry weight was achieved on day 20
• Decreased SCr by 48-52 umol/L
• Increased GFR 15-33mL/min/1.73m²
(P<0.01)
CI 95%
 Study Weaknesses
• Lack of control group
• Small sample size
• Heterogeneity of age and etiology of CHF patients
 Study strength
• 11 patients were clinically stable on the treatment with decreased
mortality
 Conclusion
• Prednisone may have potent diuretic effect.
• Improve renal function.
• Additional studies must be done to ensure efficacy and mechanism of
action.
• Prednisone can decrease mortality.
Any questions?
Thank you