Association between Diuretic Use and the Risk of Chronic Dialysis and Death in Patients with Advanced Chronic Kidney Disease

Szu-Chun Hung ； Jia-Sin Liu ； Ko-Lin Kuo ； Ching-Hsiu Peng ； Che-Hsiung Wu ； Yi-Chun Wang ； Chih-Cheng Hsu ； Der-Cherng Tarng

《Acta Nephrologica》 30卷2期 (2016/06) Pp. 70-78

https://doi.org/10.6221/AN.2016029

並列摘要

BACKGROUND: Diuretics are commonly prescribed in response to fluid retention in patients with chronic kidney disease (CKD). This study aimed to determine whether diuretic use is associated with increased risk of chronic dialysis and increased risk of death in patients with CKD. METHODS: A prospective cohort study of 295 stage 3 ~ 5 CKD patients was conducted to compare the volume status of diuretic users to those of diuretic non-users using bioimpedance (Study 1). It was followed by a nationwide population-based, propensity score-matched cohort study of 16,992 advanced CKD patients (serum creatinine ＞ 6 mg/dL) from 2000 to 2009. This later study compared renal outcome and all-cause mortality of diuretic users to those of diuretic non-users using Cox proportional hazards models (Study 2). RESULTS: In Study 1, the diuretic users were significantly more volume overloaded than the non-users (relative overhydration value: 10.8 ± 9.4 versus 6.9 ± 8.0%, P ＜ 0.001). In Study 2, the diuretic users were at significantly higher risk of chronic dialysis (hazard ratio, 1.30; 95% CI, 1.26 ~ 1.35; P ＜ 0.001) and death (hazard ratio 1.19; 95% CI, 1.11 ~ 1.28; P ＜ 0.001) when compared to the diuretic non-users. Volume overload may be an unmeasured confounding factor that is behind the relationship between diuretic use and increased chronic dialysis, and between diuretic use and increased mortality rate. CONCLUSION: Volume overload is common and may be an important mechanism contributing to adverse outcomes in patients with CKD. Although diuretic use was associated with more adverse outcomes, the association might be confounded by a greater severity of fluid retention in diuretic users. A prospective randomized study is warranted to clarify whether the correction of volume overload by diuretics would improve outcomes of patients with CKD.

並列關鍵字

chronic kidney disease ； diuretics ； mortality ； volume overload