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Loop diuretics improve conditions of dialysis inception in advanced CKD: an observational cohort study
Dogan-Firat Bozman1, Dorothée Bazin1, Frédéric Lavainne2
1Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67 000, Strasbourg, France.
Insights
Continuous loop diuretic use before dialysis initiation is linked to better dialysis start conditions and potentially lower early mortality. This suggests a protective effect of diuretics in pre-dialysis patients.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Diuretics manage fluid overload but their impact on dialysis initiation is unclear.
- The effects of loop diuretics on dialysis start conditions and early mortality need investigation.
Purpose of the Study:
- To investigate if loop diuretic exposure before dialysis delays dialysis need.
- To assess the impact on dialysis start conditions and 3-month mortality.
Main Methods:
- Adult patients initiating dialysis (2009-2015) from the REIN registry were analyzed.
- Patients were categorized into 'continuous', 'stopped', or 'no diuretics' groups based on prior year exposure.
- Outcomes included pre-dialysis hospitalization rates and 3-month mortality.
Main Results:
- Continuous diuretic use was associated with fewer emergency dialysis starts and central venous catheter insertions.
- Patients on continuous diuretics had lower prior year hospitalization rates, excluding heart failure.
- Unadjusted mortality risk was higher in 'no' or 'stopped' diuretic groups, but adjusted risk was reduced.
Conclusions:
- Continuous loop diuretic use before dialysis is linked to improved dialysis inception conditions.
- This exposure may be associated with reduced mortality within three months post-dialysis initiation.
Background:
Diuretics can reduce fluid overload but their effects on conditions of dialysis start remain elusive. We aimed to determine whether loop diuretics exposure in the year before inception can delay the need for dialysis, affect the conditions of dialysis start, and cause early mortality three months after initiation in pre-dialysis patients.
Methods:
All adult patients starting dialysis from 2009 to 2015 in the REIN registry were included. Three subgroups were defined according to diuretics exposure: "continuous", "stopped", or "no diuretics" over the year before inception and compared for pre-dialysis hospitalization rates, and 3-month mortality after dialysis.
Results:
Among 59,302 patients, we found fewer emergency initiations of dialysis in the continuous diuretics group than in the stopped diuretics and no diuretics groups: 9492 (27.5%) vs 1905 (32.3%) and 5226 (35.0%), respectively; p < 0.0001. In the continuous diuretics group, there were fewer starts on central venous catheters than in the stopped diuretics and no diuretics groups: 16,677 (49.4%) vs. 3246 (56.0%) vs. 8,639 (58.4%); p < 0.0001. Patients with continuous diuretic exposure had a lower hospitalization rate than the stopped diuretics group in the year prior to dialysis, except for heart failure. The unadjusted 3-month hazard ratio of mortality after dialysis inception was significantly higher in the "no diuretics" or "stopped diuretics" groups compared with "continuous diuretics", but the excess of risk was blunted after adjustment for emergency start and pre-dialysis visits to a nephrologist.
Conclusion:
Continuous loop diuretics exposure in the year before dialysis was associated with better conditions of dialysis inception, and possibly lower mortality rates in the three months after inception.
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