What are the side effects of diuretics on the kidneys?

Question

Hi doctor,

Three months ago, I had a heart attack, after which I underwent angioplasty with stenting. Following the heart attack, I was diagnosed with moderate systolic heart failure (HF) and an ejection fraction (EF) of 35 percent. Currently, I am taking Clopidogrel, Rosuvastatin (10 mg), Torasemide (5 mg), Metoprolol succinate, Eplerenone (25 mg), and Telmisartan (20 mg). I am making good progress; my EF improved to 40 percent during my first follow-up after a month. I have lost about 13 to 15 pounds over the last three months. I am adhering to an excellent diet and walking for about 70 minutes each day. I have completely quit smoking.

One week ago, I had my blood checked for various profiles, and I have a few queries regarding the results. My lipid levels are on the low side: total cholesterol is 123 mg/dL, HDL is 23 mg/dL, and LDL is 61 mg/dL. I was on Rosuvastatin (40 mg) for the first month and am now taking Rosuvastatin (10 mg). Am I below the target range? If so, can I reduce the dose further? Additionally, my uric acid level is high at 8.1 mg/dL. I read that this may occur due to hypertensive medications, particularly diuretics, and ARBs (angiotensin II receptor blockers). Is the elevated uric acid a cause for concern?

Should I consult my treating doctor? My kidney profile, including sodium and potassium levels, is within normal limits. My blood pressure is consistently low, averaging around 90/55 mmHg, with a heart rate ranging from 65 to 72 beats per minute. Can I reduce my medications, particularly the diuretics? I am concerned about the potential side effects of diuretics on my kidneys. My alkaline phosphatase level is 131 U/L, just three points above the upper limit of 128 U/L. Is this reading acceptable following a myocardial infarction?

Please explain.

Answer 1

Hi,

Welcome to icliniq.com.

I appreciate your concerns. After thoroughly reviewing your health query, I would like to address your questions. Please do not be overly concerned about your lipid profile; it appears to be acceptable. Continue to maintain a healthy diet. Your levels are not too low to warrant worry, and they should improve with dietary changes. Try to avoid a high-protein diet and remain physically active, as this will help bring your uric acid levels back to normal. It is not urgent to visit your doctor right now, but during your next appointment, you may want to ask your physician about reviewing your medications, considering your overall health situation.

Yes, you should contact your treating physician to discuss a dosage adjustment, particularly for the diuretics, if possible. The reason for the high-dose diuretics is to reduce the workload on your failing heart, which has a compromised ejection fraction (EF). An alkaline phosphatase level of 131, especially in this context, is not a major concern. There is no immediate need for medical intervention, as this finding is insignificant and non-specific.

I hope this helps.

Thank you.