Efficacy and Safety of Sequential Nephron Blockade Compared to Standard Loop Diuretic for Fluid De-resuscitation in the ICU.

Authors

• Noelle Brittain
• Megan Van Berkel Patel
• Lauren Caldwell
• Andrew Shine
• Jeremy Greenberg
• Jessica Parker, Corewell Health West
• Nolan Rossman, Corewell Health West
• Jessica Briscoe

Document Type

Article

Publication Date

8-2026

Publication Title

Journal of Pharmacy Practice

Abstract

Diuretics are integral in fluid de-resuscitation of ICU patients following initial stabilization. While loop diuretics are commonly used, sequential nephron blockade (SNB) is an alternative diuretic strategy that combines a loop diuretic with at least one diuretic from another pharmacologic class to increase efficacy and limit adverse effects. The objective of this study was to compare the safety and efficacy of SNB to loop diuretics alone for de-resuscitation of critically ill patients. This retrospective study included adult ICU patients who received either a loop diuretic alone or combined with an aldosterone antagonist, carbonic anhydrase inhibitor, and/or thiazide diuretic on two consecutive days. The primary outcome was comparison of diuretic efficacy, assessed by urine output, on diuresis day 1. Secondary outcomes included comparison of diuretic efficacy on diuresis days 2-5 and incidence of acute kidney injury and electrolyte abnormalities on diuresis day 1. A total of 100 patients were included (SNB = 15, Loop = 85). At baseline, SNB patients had more hypernatremia (20% vs 2.4%,

First Page

8971900261477835

Last Page

8971900261477835

Recommended Citation

Brittain N, Van Berkel Patel M, Caldwell L, Shine A, Greenberg J, Parker J, et al. [Rossman N]. Efficacy and safety of sequential nephron blockade compared to standard loop diuretic for fluid de-resuscitation in the ICU. J Pharm Pract. 2026:8971900261477835. doi: 10.1177/08971900261477835. PMID: 42604812.

DOI

10.1177/08971900261477835

ISSN

1531-1937

PubMed ID

42604812