Diuretic Use Among Hemodialysis Patients in Lebanon: A Multicenter Observational Retrospective Study

Despite their fundamental role in managing volume overload, diuretic use in hemodialysis patients is inconsistent. This study aims to examine diuretic use, compare clinical outcomes between diuretic users and nonusers, and identify predictive factors among hemodialysis patients in Lebanon.

This was a multicenter retrospective observational study. Patients' data were retrieved from eight large dialysis centers in Lebanon. Descriptive and bivariate analyses were performed, followed by multivariable logistic regression to examine the association of diuretic use with the sociodemographic, hemodialysis parameters, and clinical outcomes of patients.

A total of 250 patients were included in the study. Diuretics were utilized among 38.4% of the patients, all of whom were on loop diuretics, primarily furosemide (71.3%). The mean furosemide equivalent dose was 153.56 ± 122.57 mg per day (range 20-500 mg). Only 28.7% and 16.1% were on furosemide equivalent doses of at least 250 mg and 320 mg per day, respectively. Diuretic users were more likely to have a residual kidney function (ORa = 23.189, 95% CI: 5.129-104.831, p < 0.001), a shorter dialysis vintage (ORa = 0.892, 95% CI: 0.472-0.958, p = 0.046), and a higher postdialysis systolic blood pressure (ORa = 13.760, 95% CI: 10.381-18.232, p = 0.026) compared to nonusers. Other hemodialysis parameters and clinical outcomes did not differ between diuretic users and nonusers. Furosemide equivalent doses of at least 250 mg per day were significantly associated with lower predialysis systolic blood pressure and dry weight, while doses of 320 mg and more per day were significantly associated with fewer intradialytic hypotension episodes, lower predialysis systolic blood pressure, dry weight, and interdialytic weight gain (all p < 0.05).

This study reveals suboptimal dosing despite a relatively high prevalence of utilization of diuretics among hemodialysis patients. Most hemodialysis parameters and clinical outcomes do not differ between diuretic users and nonusers. Higher diuretic doses are associated with improved clinical outcomes, emphasizing the need for further research to optimize dosing practices in this population.