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Chronic Kidney Disease, Fluid Overload and Diuretics: A Complicated Triangle

Yusra Habib Khan1,2, Azmi Sarriff1, Azreen Syazril Adnan2

  • 1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, 11800, Malaysia.

Plos One
|July 22, 2016
PubMed

Insights

Diuretic use in chronic kidney disease (CKD) patients is linked to worsening kidney function and a higher risk of needing renal replacement therapy (RRT). Careful consideration of risks versus benefits is advised for diuretic prescription.

Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Diuretics are commonly used to manage fluid overload in chronic kidney disease (CKD) patients.
  • However, diuretic therapy may be associated with adverse renal outcomes.
  • The extent of renal deterioration linked to diuretic use in non-dialysis dependent CKD (NDD-CKD) requires further investigation.

Purpose of the Study:

  • To determine the impact of diuretic therapy on renal function in NDD-CKD patients.
  • To assess the association between diuretic use and the decline in estimated glomerular filtration rate (eGFR).
  • To evaluate the relationship between diuretic use and the initiation of renal replacement therapy (RRT).

Main Methods:

  • A prospective cohort study followed 312 NDD-CKD patients for one year.
  • Fluid overload was assessed using bioimpedance spectroscopy.
  • Estimated GFR (eGFR) was calculated using the CKD-EPI equation from serum creatinine.

Main Results:

  • Of 312 patients, 135 (43.4%) were hypervolemic, 113 (36.1%) euvolemic, and 64 (20.5%) hypovolemic.
  • Diuretic use was observed in 144 patients, predominantly those who were hypervolemic (72.6%).
  • The mean eGFR decline was -2.5 ± 1.4 ml/min/1.73m2 over one year, significantly associated with diuretic use.
  • 36 patients (11.5%) initiated RRT, with a higher incidence among diuretic users.

Conclusions:

  • Diuretic use in NDD-CKD patients is associated with adverse renal outcomes, including eGFR decline.
  • Diuretic therapy increases the risk of initiating renal replacement therapy.
  • Cautious prescription of diuretics is recommended, balancing potential benefits against renal harm.
Abstract

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