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Are Diuretics Underutilized in Dialysis Patients?

Emilie Trinh¹, Joanne M Bargman²

¹Division of Nephrology, University Health Network, Toronto, Ontario, Canada.

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|April 11, 2016

Summary

Diuretics are underutilized in dialysis patients despite benefits for fluid management and blood pressure. This review explores their advantages and optimal use in peritoneal dialysis and hemodialysis, even with residual kidney function.

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Area of Science:

Nephrology and Pharmacology
Renal Medicine and Therapeutics

Background:

Oral diuretics are standard for chronic kidney disease (CKD) but often stopped during dialysis.
Significant underutilization of diuretics in peritoneal dialysis (PD) and hemodialysis (HD) patients is observed.
Suboptimal dosing is common when diuretics are prescribed for dialysis patients.

Discussion:

Diuretics can improve volume status in PD, reducing reliance on high-glucose solutions.
In HD, diuretics help manage interdialytic weight gain, lower ultrafiltration rates, and prevent intradialytic hypotension.
The review examines diuretic mechanisms in renal insufficiency, side effect risks, and benefits for dialysis patients with residual renal function.

Key Insights:

Diuretics offer significant benefits for fluid and blood pressure management in dialysis patients.
Potential advantages outweigh the risks, especially in patients with preserved residual kidney function.
Optimizing diuretic use can enhance patient outcomes and quality of life during dialysis.

Outlook:

Further research into optimal diuretic strategies for dialysis populations is warranted.
Clinical practice should reconsider the role of diuretics in PD and HD patients.
Increased awareness and education can promote the appropriate use of diuretics in renal care.