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Outcomes of diuretic use in pre-dialysis CKD patients with moderate renal deterioration attending tertiary care referral center

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Abstract

Introduction

Diuretic therapy has been the mainstay of treatment in chronic kidney disease (CKD) patients, primarily for hypertension and fluid overload. Apart from their beneficial effects, diuretic use is associated with adverse renal outcomes. The current study is aimed to determine the outcomes of diuretic therapy.

Methodology

A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by Bioimpedance analysis (BIA).

Results

A total 312 patients (mean age 64.5 ± 6.43) were enrolled. Among 144 (46.1%) diuretic users, furosemide and hydrochlorothiazide (HCTZ) were prescribed in 69 (48%) and 39 (27%) patients, respectively, while 36 (25%) were prescribed with combination therapy (furosemide plus HCTZ). Changes in BP, fluid compartments, eGFR decline and progression to RRT were assessed over a follow-up period of 1 year. Maximum BP control was observed with combination therapy (−19.3 mmHg, p < 0.001) followed by furosemide [−10.6 mmHg with 80 mg thrice daily (p < 0.001)], −9.3 mmHg with 40–60 mg (p < 0.001) and −5.9 mmHg with 20–40 mg (p = 0.02) while HCTZ offered minimal SBP control [−3.7 mmHg with 12.5–25 mg (p = 0.04)]. Decline in extracellular water (ECW) ranged from −1.5 L(p = 0.01) with thiazide diuretics to −3.8 L(p < 0.001) with combination diuretics. Decline in eGFR was maximum (−3.4 ml/min/1.73 m2, p = 0.01) with combination diuretics and least with thiazide diuretics (−1.6 ml/min/1.73 m2, p = 0.04). Progression to RRT was observed in 36 patients.

Conclusion

It is cautiously suggested to discourage the use of diuretic combination therapy and high doses of single diuretic therapy. Prescribing of diuretics should be done by keeping in view benefit versus harm for each patient.

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Acknowledgements

We are thankful to CKD resource center staff for providing assistance for data collection and handling.

Author contributions

(1) YKH, THM, AHK have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; (2) YHK and ASA have been involved in drafting the manuscript or revising it critically for important intellectual content; and (3) AS, AHK and ASA have given final approval of the version to be published. Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content.

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Authors and Affiliations

  1. Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, 11800,, Gelugor, Penang, Malaysia

    Yusra Habib Khan, Azmi Sarriff, Amer Hayat Khan & Tauqeer Hussain Mallhi

  2. Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kubang Kerain, Kelantan, Malaysia

    Yusra Habib Khan, Azreen Syazril Adnan & Tauqeer Hussain Mallhi

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  1. Yusra Habib Khan
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  2. Azmi Sarriff
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Correspondence to Yusra Habib Khan.

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Ethical approval

Current study was approved by ethical committee of Hospital University Sains Malaysia [Jawatankuasa Etika Penyelidikan (Manusia) of USM (JEPeM)]. All the patients were asked to sign consent before participating in the study. Identity of each patient was kept confidential and patients were anonymized during data analysis (Reference: USM/JEPeM/131153).

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The authors declare that they have no competing interests.

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Khan, Y.H., Sarriff, A., Adnan, A.S. et al. Outcomes of diuretic use in pre-dialysis CKD patients with moderate renal deterioration attending tertiary care referral center. Clin Exp Nephrol 21, 1011–1023 (2017). https://doi.org/10.1007/s10157-017-1397-6

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  • DOI: https://doi.org/10.1007/s10157-017-1397-6

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