The Effect of Hypervolemia Control on Proteinuria in Kidney Disease: A Prospective Interventional Study

Proteinuria reduction has been extensively studied in patients with chronic kidney disease. However, the effects of diuretic treatment on proteinuria are less well-documented. This study aimed to evaluate the effects of strict volume control, achieved through diuretic therapy, on proteinuria among patients with proteinuric kidney disease and concurrent hypervolemia, as measured by bioimpedance analysis (BIA).

This prospective study included patients with proteinuria as indicated by spot urine analysis, an overhydration (OH) value of >0 in BIA, and a treatment plan that included diuretics. The follow-up period extended from the initiation of diuretic therapy, prompted by hypervolemic status, to the achievement of normovolemia in each patient.

We evaluated 46 hypervolemic patients, of which 25 (54.3%) were men and 39 (64%) were women, with a mean age of 56.85±14.43 years (range 20 to 86 years). The median follow-up period was 12 days (range 5-90 days). After diuretic treatment, there was a statistically significant decrease in both systolic and diastolic blood pressure (p<0.001 for both). Initially, protein excretion in spot urine averaged 6.3 g (range 2.6-10.4 g); following volume control, proteinuria level decreased significantly to 1.5 g (range 0.6-2.9 g) (p<0.001). Additionally, regression analysis indicated a statistically significant association between the decrease in extracellular water and the decline in proteinuria levels (p=0.035).

Our findings demonstrate that volume control, achieved through diuretic treatment, is associated with reductions in both proteinuria and blood pressure.