Diuretics prescribing in chronic kidney disease patients: physician assessment versus bioimpedence spectroscopy
Yusra Habib Khan1,2, Azmi Sarriff3, Azreen Syazril Adnan4
1School of Pharmaceutical Sciences, University Sains Malaysia, 11800, Penang, Malaysia. yusrahabib@ymail.com.
Insights
Bioimpedance spectroscopy (BIS) helps identify fluid overload in pre-dialysis chronic kidney disease (CKD) patients. This technology can guide personalized diuretic therapy for managing hypertension in CKD.
Area of Science:
- Nephrology
- Cardiology
- Medical Technology
Background:
- Hypertension and fluid overload are common in pre-dialysis chronic kidney disease (CKD) patients.
- The precise relationship between these conditions and the role of diuretic therapy requires further elucidation.
- Bioimpedance spectroscopy (BIS) offers a potential tool for assessing fluid status.
Purpose of the Study:
- To investigate the relationship between fluid overload and hypertension in pre-dialysis CKD patients.
- To evaluate the utility of BIS in assessing fluid status and guiding diuretic therapy.
- To analyze diuretic prescription patterns based on fluid status and blood pressure.
Main Methods:
- A prospective observational study involving 312 pre-dialysis CKD patients.
- Fluid overload was assessed using BIS and categorized using a hydration reference plot (HRP).
- Diuretic prescriptions were analyzed in relation to patient categorization on the HRP.
Main Results:
- 43.3% of patients exhibited hypervolemia (fluid overload).
- BIS categorized patients into distinct groups based on hydration and blood pressure, with significant proportions in hypertensive and fluid-overloaded states (Regions I and I-II).
- Diuretics were most frequently prescribed for hypertensive and fluid-overloaded patients, but also inappropriately in some under-hydrated patients.
Conclusions:
- BIS effectively categorizes CKD patients based on fluid status.
- This categorization can inform individualized pharmacotherapy for managing hypertension in CKD.
- BIS may help optimize diuretic use and improve patient management.
Introduction:
The relationship between hypertension and fluid overload in pre-dialysis CKD patients need to be elucidated. Current study aimed to find relationship between fluid overload and hypertension along with prescribed diuretic therapy using bioimpedance spectroscopy (BIS).
Methodology:
A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by BIS.
Results:
A total of 312 CKD patients with mean eGFR 24.5 ± 11.2 ml/min/1.73 m2 were enrolled. Based on OH value ≥7 %, 135 (43.3 %) patients were hypervolemic while euvolemia was observed in 177 (56.7 %) patients. Patients were categorized in different regions of hydration reference plot (HRP) generated by BIS i.e., 5.1 % in region-N (normal BP and fluid status), 20.5 % in region I (hypertensive with severe fluid overload), 29.5 % in region I-II (hypertensive with mild fluid overload), 22 % in region II (hypertensive with normohydration), 10.2 % in region III (underhydration with normal/low BP) and 12.5 % in region IV (normal BP with severe fluid overload). A total of 144 (46 %) patients received diuretics on basis of physician assessment of BP and edema. Maximum diuretics 100 (69.4 %) were prescribed in patients belonging to regions I and I-II of HRP. Interestingly, a similar number of diuretic prescriptions were observed in region II (13 %) and region IV (12 %). Surprisingly, 7 (4.9 %) of patients in region III who were neither hypervolemic nor hypertensive were also prescribed with diuretics.
Conclusion:
BIS can aid clinicians to categorize CKD patients on basis of their fluid status and provide individualized pharmacotherapy to manage hypertensive CKD patients.
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