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Schork, A. ; Vogel, E. ; Bohnert, B.N. ; Essigke, D. ; Wörn, M. ; Fischer, I.* ; Heyne, N. ; Birkenfeld, A.L. ; Artunc, F.

Amiloride versus furosemide for the treatment of edema in patients with nephrotic syndrome: A pilot study (AMILOR).

Acta Physiol. 240:e14183 (2024)
Publ. Version/Full Text DOI PMC
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AIM: In rodent models of nephrotic syndrome (NS), edema formation was prevented by blockade of the epithelial sodium channel ENaC with amiloride. However, apart from case reports, there is no evidence favoring ENaC blockade in patients with NS. METHODS: The monocentric randomized controlled AMILOR study investigated the antiedematous effect of amiloride (starting dose 5 mg/day, max. 15 mg/day) in comparison to standard therapy with the loop diuretic furosemide (40 mg/day, max. 120 mg/day) over 16 days. Overhydration (OH) was measured by bioimpedance spectroscopy (BCM, Fresenius). Depending on the OH response, diuretic dose was adjusted on days 2, 5, 8 and 12, and if necessary, hydrochlorothiazide (HCT) was added from d8 (12.5 mg/day, max. 25 mg/day). The primary endpoint was the decrease in OH on d8. The study was terminated prematurely due to insufficient recruitment and a low statistical power due to a low actual effect size. RESULTS: Median baseline OH was +26.4 (interquartile range 15.5-35.1)% extracellular water (ECW) in the amiloride arm and + 27.9 (24.1-29.4)% ECW in the furosemide arm and decreased by 1.95 (0.80-6.40) and 5.15 (0.90-8.30)% ECW after 8 days, respectively, and by 10.10 (1.30-14.40) and 7.40 (2.80-10.10)% ECW after 16 days, respectively. OH decrease on d8 and d16 was not significantly different between both arms. CONCLUSION: The AMILOR study is the first randomized controlled pilot study suggesting a similar antiedematous effect as furosemide. Further studies are required to better define the role of amiloride in NS (EudraCT 2019-002607-18).
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Amiloride ; Edema ; Epithelial Sodium Channels ; Furosemide ; Nephrotic Syndrome; Epithelial Sodium-channel; Retention; Activation; Trial
ISSN (print) / ISBN 1748-1708
e-ISSN 1748-1716
Journal Acta Physiologica
Quellenangaben Volume: 240, Issue: 8, Pages: , Article Number: e14183 Supplement: ,
Publisher Wiley
Publishing Place Hoboken
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Diabetes Research and Metabolic Diseases (IDM)
Grants Projekt DEAL
MINT-Clinician Scientist program of the Medical Faculty Tuebingen - German Research Foundation
TUEFF program of the Medical Faculty of Tuebingen University
German Research Foundation (DFG)
Medical Faculty of Tuebingen University