Hemodialysis Patients May Benefit by Staying on Loop Diuretics
Patients who remain on loop diuretics after starting hemodialysis have lower rates of hospitalization and intradialytic hypotension, a study found.
Continuing patients on loop diuretics following hemodialysis (HD) initiation is associated with significantly decreased rates of hospitalization and intradialytic hypotension, but is not associated with mortality over the first year of HD.
Scott Sibbel, PhD, of DaVita Clinical Research in Minneapolis, Minnesota, and colleagues identified 11,297 patients who had an active supply of a loop diuretic at the start of HD. Of these, 5219 patients refilled a loop diuretic following HD initiation and 6078 did not (controls). Patients had up to 12 months of follow-up.
The hospitalization rate was 1.84 admissions per patient-year among patients who continued on loop diuretics compared with 2.10 among controls, the investigators reported in the Clinical Journal of the American Society of Nephrology. The intradialytic hypotension rate was 22.7 episodes per patient-year in the diuretic continuation group compared with 24.3 in the control arm. In adjusted analyses, the incident rate ratios for hospitalizations and intradialytic hypotension were 0.93 and 0.95, respectively.
The diuretic continuation group also experienced less interdialytic weight gain than controls (mean 1.8 vs 1.9 kg). The death rate did not differ between the groups (0.18 vs 0.23 deaths per patient-year).
Sibbel S, Walker AG, Colson C, et al. Association of continuation of loop diuretics at hemodialysis initiation with clinical outcomes. Clin J Am Soc Nephrol. 2018; published online ahead of print.