Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes.

Autor:	Sibbel S; DaVita Clinical Research, Minneapolis, Minnesota., Walker AG; DaVita Clinical Research, Minneapolis, Minnesota., Colson C; DaVita Clinical Research, Minneapolis, Minnesota., Tentori F; DaVita Clinical Research, Minneapolis, Minnesota., Brunelli SM; DaVita Clinical Research, Minneapolis, Minnesota., Flythe J; Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina; and.; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2019 Jan 07; Vol. 14 (1), pp. 95-102. Date of Electronic Publication: 2018 Dec 19.
DOI:	10.2215/CJN.05080418
Abstrakt:	Background and Objectives: Loop diuretics are commonly used to manage nondialysis-dependent CKD. Despite benefits of augmented urine output, loop diuretics are often discontinued after dialysis initiation. Here, we assessed the association of the early decision to continue loop diuretics at hemodialysis start with clinical outcomes during the first year of dialysis. Design, Setting, Participants, & Measurements: We considered all patients on in-center hemodialysis at a large dialysis organization (2006-2013) with Medicare Part A and D benefits who had an active supply of a loop diuretic at dialysis initiation ( n =11,297). Active therapy was determined on the basis of whether loop diuretic prescription was refilled after dialysis initiation and within 30 days of exhaustion of prior supply. Patients were followed under an intention-to-treat paradigm for up to 12 months for rates of death, hospitalization, and intradialytic hypotension and mean monthly values of interdialytic weight gain, serum potassium, predialysis systolic BP, and ultrafiltration rates. Results: We identified 5219 patients who refilled a loop diuretic and 6078 eligible controls who did not. After adjustments for patient mix and clinical differences, continuation of loop diuretics was associated with lower hospitalization (adjusted incidence rate ratio, 0.93; 95% confidence interval, 0.89 to 0.98) and intradialytic hypotension (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.92 to 0.99) rates, no difference in death rate (adjusted hazard ratio, 0.92; 95% confidence interval, 0.84 to 1.01), and lower interdialytic weight gain ( P =0.03). Conclusions: Continuation of loop diuretics after hemodialysis initiation was associated with lower rates of hospitalization and intradialytic hypotension as well as lower interdialytic weight gain, but there was no difference in mortality over the first year of dialysis. (Copyright © 2019 by the American Society of Nephrology.)
Databáze:	MEDLINE
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