Measures of Loop Diuretic Efficiency and Prognosis in Chronic Kidney Disease

Abstract

Background: The evolution and prognostic impact of loop diuretic efficiency according to chronic kidney disease (CKD) severity is unclear. Methods: This retrospective cohort study includes 783 CKD patients on oral loop diuretic therapy with a 24-h urine collection available. Acute kidney injury and history of renal replacement therapy were exclusion criteria. Patients were stratified according to Kidney Disease Improving Global Outcomes (KDIGO) glomerular filtration rate class. Loop diuretic efficiency was calculated as urine output, natriuresis, and chloruresis, each adjusted for loop diuretic dose, and compared among strata. Risk for onset of dialysis and all-cause mortality was evaluated. Results: Loop diuretic efficiency metrics decreased from KDIGO class IIIB to IV in furosemide users and from KDIGO class IV to V with all loop diuretics ( p value <0.05 for all comparisons). The correlation between loop diuretic efficiency and creatinine clearance was moderate at best (Spearman’s ρ 0.298–0.436; p value <0.001 for all correlations). During median follow-up of 45 months, 457 patients died (58%) and 63 received kidney transplantation (8%), while dialysis was started before in 328 (42%). All loop diuretic efficiency metrics were significantly and independently associated with both the risk for dialysis and all-cause mortality. In KDIGO class IV/V patients, low loop diuretic efficiency (i.e., urine output adjusted for loop diuretic dose ≤1,000 mL) shortened median time to dialysis with 24 months and median time to all-cause mortality with 23 months. Conclusion: Low loop diuretic efficiency is independently associated with a shorter time to dialysis initiation and a higher risk for all-cause mortality in CKD.

Journal

Journal ID (publisher-id): CRM

Journal ID (nlm-ta): Cardiorenal Med

Journal ID (doi): 10.1159/issn.1664-5502

Title: Cardiorenal Medicine

Publisher: S. Karger AG

ISSN (Print): 1664-3828

ISSN (Electronic): 1664-5502

Publication date Subscription-year: 2020

Publication date (Print): December 2020

Publication date (Electronic): 29 October 2020

Volume: 10

Issue: 6

Pages: 402-414

Affiliations

_aDepartment of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium

_bBiomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

_cDepartment of Cardiology, Jessa Hospital, Hasselt, Belgium

_dDepartment of Cardiovascular Medicine, Yale Medical Center, New Haven, Connecticut, USA

_eHeart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA

_fNephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium

Author notes

*Frederik H. Verbrugge, Department of Nephrology, University Hospital Leuven, Herestraat 49, BE–3000 Leuven (Belgium), [e-mail]

Article

Publisher ID: 509741 Other ID: Cardiorenal Med 2020;10:402–414

DOI: 10.1159/000509741

PubMed ID: 33120398

Copyright statement: © 2020 S. Karger AG, Basel

License:

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Page count

Figures: 4, Tables: 2, Pages: 13

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Categories

Subject: Research Article