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Review
. 2025 May 25.
doi: 10.1007/s41999-025-01229-5. Online ahead of print.

Effectiveness and safety of chronic diuretic use in older adults: an umbrella review of recently published systematic reviews and meta-analyses of randomized-controlled trials

Eveline van Poelgeest  1   2 , Konstantinos Prokopidis  3 , Tuğba Erdogan  4 , Min Ji Kwak  5 , Karolina Piotrowicz  6 , Luca Paoletti  7 , Annette Eidam  8 , Fatma Özge Kayhan Koçak  9 , Birkan Ilhan  10 , Alessia Beccacece  11 , George Soulis  12 , Serdar Özkök  4 , Gulistan Bahat  13 , Eva Topinková  14   15 , Joost Daams  16 , M Louis Handoko  17   18 , Parag Goyal  19 , Jerzy Gąsowski  6 , Antonio Cherubini  11   20 , Nicola Veronese  21 , Giuseppe Dario Testa  22 , Wade Thompson  23 , Nathalie van der Velde  24   25 ; European Geriatric Medicine Society Special Interest Groups of i. Pharmacology; ii. Cardiovascular Disease and iii. Systematic Review and Meta-analysis
Affiliations
Review

Effectiveness and safety of chronic diuretic use in older adults: an umbrella review of recently published systematic reviews and meta-analyses of randomized-controlled trials

Eveline van Poelgeest et al. Eur Geriatr Med. .

Abstract

Background: Healthcare providers should balance the potential risks and benefits of chronic diuretic use, particularly in older adults, as with age, diuretic benefits may decline and risks increase. A comprehensive synthesis and critical evaluation of the available evidence on chronic diuretic treatment effects is currently lacking.

Methods: We conducted an umbrella review of systematic reviews and meta-analyses published since 2018 on health outcomes associated with diuretic use in randomized-controlled trials (RCTs). We conducted random-effects meta-analysis for pooled effect estimates and narratively summarized data that could not be pooled.

Results: We included 741 effect estimations from 117 systematic reviews (SRs) on 1566 RCTs in individuals aged 62 ± 6 years. Of our 33 meta-analyses, 11 provided convincing, high-quality evidence: finerenone reduced the risk of cardiovascular (CV) mortality and end-stage kidney disease in individuals with chronic kidney disease (CKD) and/or type 2 diabetes (T2D). Torasemide reduced the risk of heart failure-related hospitalization (HFH) more than furosemide in individuals with HF. Thiazides reduced CV events in individuals with hypertension. Mineralocorticoid receptor antagonists (MRAs) reduced HFH, but also increased hyperkalemia risk in individuals with HF. MRAs also reduced the risk of atrial fibrillation in those with HF or CVD, and reduced HFH, major adverse cardiovascular events (MACEs), > 40% eGFR decrease, and composite kidney outcomes in individuals with CKD and/or T2D. Lower quality evidence suggests that in older (≥ 65 years), but not in younger adults, diuretics may reduce CV mortality, but also increase adverse event (AE) risk.

Conclusions: Our umbrella review offers a comprehensive and up-to-date evaluation of the benefits and harms of diuretics. However, further research is needed to establish their efficacy and safety in populations commonly seen in clinical practice, especially older adults living with multimorbidity and frailty.

Keywords: Adverse outcome; Benefit; Diuretics; Efficacy; Meta-analysis; Umbrella review.

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Conflict of interest statement

Declarations. Conflict of interest: Min Ji Kwak received a research grant from the US Deprescribing Research Network, receives consult fees from Novo Nordisk, and owns stocks in Eli Lilly and Novo Nordisk. Louis Handoko is supported by a research grant of the Dutch Heart Foundation (NHS; 2020T058), the Amsterdam Cardiovascular Sciences (ACS) Institute, The Netherlands Organization for Scientific Research (NWO), and funding for an investigator-initiated study of Vifor Pharma. He received an educational grant and/or speaker/consultancy fees from Novartis, Boehringer Ingelheim, Daiichi Sankyo, Vifor Pharma, AstraZeneca, Bayer, MSD, and Abbott; all not related to this work. Parag Goyal is supported by National Institute on Aging grants K76AG064428 and R21AG077092. Dr. Goyal was a member of the Junior Investigator Intensive Program of the US Deprescribing Research Network and is supported by a US Deprescribing Research Pilot Grant, which are funded by the National Institute on Aging (R24AG064025). He has received consulting fees from Sensorum Health, Agepha Pharma, and Axon therapies; and has received personal fees for medicolegal consulting and expert testimony related to HF. Jerzy Gąsowski has given talks on the topic of anti-hypertensive therapy in older persons and deprescribing, some of which were associated with lecture fees. Wade Thompson has received grants for deprescribing research from Health Canada and the National Institute on Aging (US), is supported by a salary award from Michael Smith Health Research British Columbia; and receives an honorarium for writing an article on deprescribing in Pharmacy Practice Plus magazine. Eva Topinkova work was partly supported by the Project New Technologies in Translational Research in Pharmaceutical Sciences/NETPHARM reg. No. CZ.02.01.01/00/22_008/0004607, co-financed by the European Union. George Soulis has received consulting fees by Reckitt Benckiser for Advisory Board. All other authors have no conflict of interest to declare. Ethics approval: N/A. Informed consent: For this type of study, formal consent is not required.

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References

    1. Filbey L, Zhu JW, D’Angelo F, Thabane L, Khan MS, Lewis E et al (2023) Improving representativeness in trials: a call to action from the Global Cardiovascular Clinical Trialists Forum. Eur Heart J 44(11):921–930. https://doi.org/10.1093/eurheartj/ehac810 - DOI - PubMed - PMC
    1. Coll PP, Roche V, Olsen JS, Voit JH, Bowen E, Kumar M (2020) The prevention of cardiovascular disease in older adults. J Am Geriatr Soc 68(5):1098–1106. https://doi.org/10.1111/jgs.16353 - DOI - PubMed
    1. Forman DE, Maurer MS, Boyd C, Brindis R, Salive ME, Home FM et al (2018) Multimorbidity in older adults with cardiovascular disease. J Am Coll Cardiol 71(19):2149–2161. https://doi.org/10.1016/j.jacc.2018.03.022 - DOI - PubMed - PMC
    1. Ellison DH, Felker GM (2018) Diuretic treatment in heart failure. New Engl J Med 378(7):684–685 - PubMed
    1. Reinhart M, Puil L, Salzwedel DM, Wright JM (2023) First-line diuretics versus other classes of anti-hypertensive drugs for hypertension. Cochrane Database Syst Rev 7:ARTN CD008161. https://doi.org/10.1002/14651858.CD008161.pub3 - DOI