Long-term bumetanide treatment of renal edema. Comparison with furosemide.

In an open, parallel, randomized study, bumetanide was compared with furosemide in the long-term management of patients with severe renal edema. The doses used were: bumetanide, 1 mg; furosemide, 40 mg. Graded increases were administered to daily maxima of 10 mg bumetanide and 400 mg furosemide. The efficacy of parameters measured were: weight, recumbent and standing pulse and blood pressure, abdominal girth, and estimated degree of malaise or fatigue when present. Safety parameters included: physical examination, CBC and platelets, blood chemistry, chemical and microscopic urinalysis, creatinine clearance, air audiometry, and ophthalmic examination. Weight loss and reduction of edema and of mean arterial pressure occurred in both groups of patients. In the bumetanide-treated group, weight loss was statistically significant at most observation times during the first eight weeks, and reduction in edema was significant throughout the trial (P less than 0.05). Reduction in these parameters in the furosemide-treated patients was not statistically significant. However, the differences between the diuresis and other changes produced by the two drugs were not significant. While reduction in the mean arterial pressure of patients on bumetanide was significant (P less than 0.05), the difference with that in the furosemide treatment group was not significant. Serum electrolyte abnormalities were infrequent. All patients tolerated the drug trial well. No deterioration in audiometry occurred in any patients, including 12 who entered the trial with abnormal air audiograms. Both drugs appear to be equally safe. While a daily dose of 4.2 mg bumetanide is highly effective in severe renal edema, the design of the study did not warrant definitive conclusion regarding comparative efficacy with furosemide.