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

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.