Yusra Habib
University Sains Malaysia, Kelantan, Malaysia
Title: Impact of diuretic therapy on renal outcomes of chronic kidney disease patients
Biography
Biography: Yusra Habib
Abstract
Diuretic therapy has been mainstay of treatment in chronic kidney disease (CKD) patients, primarily for hypertension and fluid overload. Apart from their beneficial effects, diuretic use is associated with adverse renal outcomes. Current study aimed to determine outcomes of diuretic therapy. A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by Bioimpedance analysis (BIA). A total 312 patients (mean age 64.5 ± 6.43) were enrolled. Among 144 (46.1%) diuretic users, furosemide and hydrochlorothiazide (HCTZ) were prescribed in 69 (48%) and 39 (27%) patients respectively, while 36 (25%) prescribed with combination therapy (furosemide plus HCTZ). Changes in BP, fluid compartments, eGFR decline and progression to RRT were assessed over a follow-up period of 1 year. Maximum BP control was observed with combination therapy (-19.3 mmHg, p<0.001) followed by furosemide (-10.6 mmHg with 80 mg thrice daily (p<0.001)), -9.3 mmHg with 40-60 mg (p<0.001) & -5.9 mmHg with 20-40 mg (p=0.02) while HCTZ offered minimal SBP control (-3.7 mmHg with 12.5-25mg (p=0.04)). Decline in extracellular water (ECW) ranged from -1.5L (p=0.01) with thiazide diuretics to -3.8L (p<0.001) with combination diuretics. Decline in eGFR was maximum (-3.4 ml/min/1.73m2, p=0.01) with combination diuretics and least with thiazide diuretics (-1.6 ml/min/1.73m2, p=0.04). Progression to RRT was observed in 36 patients. It is cautiously suggested to discourage the use of diuretic combination therapy and high doses of single diuretic therapy. Prescribing of diuretics should be done by keeping in view benefit versus harm for each patient.