Continuation of Loop Diuretics Beneficial in First Year after Dialysis Initiation

New Orleans—Patients with non-dialysis dependent chronic kidney disease are often managed with use of loop diuretics. Upon initiation of hemodialysis, loop diuretics are often discontinued, despite potential benefits of augmented urine output. Researchers, led by Steven M. Brunelli, MD, recently conducted an analysis designed to examine the association between the early decision to continue versus discontinue loop diuretics at start of dialysis and clinical outcomes during the first year following dialysis initiation.

Results of the analysis were reported during a poster session at Kidney Week 2017. The poster was titled Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes.

The analysis included all patients who initiated in-center hemodialysis at a large dialysis organization from 2007 to 2013. Eligible patients were covered by Medicare parts A and D who had an active supply of loop diuretics at the start of dialysis (n=11,297). Exposure status was determined based on whether the prescription for loop diuretics was refilled following initiation of dialysis or within 30 days of depletion of prior supply. Follow-up on an intention-to-treat basis continued for up to 12 months; outcomes of interest were death, hospitalization, or intradialytic hypotension (IDH).

Of the 11,297 patients, 5219 refilled a prescription for loop diuretics and 6078 did not. Following adjustments for case mix and clinical differences, compared with discontinuation of loop diuretics, there was an association between continuation of loop diuretics and lower rate of hospitalization (P<.001) and IDH (P<.001), and a lower death rate (did not reach statistical significance).

In conclusion, the researchers said, “Among incident hemodialysis patients, continuation of loop diuretics in the immediate post-transition period was associated with lower rates of hospitalization and IDH over the first year of dialysis. The practice of discontinuing loop diuretics should be re-evaluated,” the researchers said.

Source: Brunelli S, Sibbel S, Walker AG, Colson C, Tentori F, Flythe JE. Association of continuation of loop diuretics at hemodialysis initiation with clinical outcomes. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 2, 2017, New Orleans, Louisiana.

Funding for this poster was provided by DaVita, Inc.