Effect of Diuretic Use on 30-Day Postdialysis Mortality in Critically Ill Patients Receiving Acute Dialysis

Abstract

BackgroundThe impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.Methods and ResultsIn this prospective, multicenter, observational study, 572 patients with postsurgical acute kidney injury receiving hemodialysis were recruited and followed daily. Thirty-day postdialysis mortality was analyzed using Cox's proportional hazards model with time-dependent covariates. The mean age of the 572 patients was 60.8±16.6 years. Patients with lower serum creatinine (p = 0.031) and blood lactate (p = 0.033) at ICU admission, lower predialysis urine output (p = 0.001) and PaO2/FiO2 (p = 0.039), as well as diabetes (p = 0.037) and heart failure (p = 0.049) were more likely to receive diuretics. A total of 280 (49.0%) patients died within 30 days after acute dialysis initiation. The analysis of 30-day postdialysis mortality by fitting propensity score-adjusted Cox's proportional hazards models with time-dependent covariates showed that higher 3-day accumulated diuretic doses after dialysis initiation (HR = 1.449, p = 0.021) could increase the hazard rate of death. Moreover, higher time-varying 3-day accumulative diuretic doses were associated with hypotension (p<0.001) and less intense hemodialysis (p<0.001) during the acute dialysis period.Background and SignificanceHigher time-varying 3-day accumulative diuretic dose predicts mortality in postsurgical critically ill patients requiring acute dialysis. Higher diuretic doses are associated with hypotension and a lower intensity of dialysis. Caution should be employed before loop diuretics are administered to postsurgical patients during the acute dialysis period.

Ketoanalogues supplementation decreases dialysis and mortality risk in patients with anemic advanced chronic kidney disease

“…This approach permits adjustments for possible nonlinear effects of continuous variables [32, 33]. To show the effect of KA dosage on risk of initiating long-term dialysis, we plotted a function curve with values of the logs of odds ratios.…”

The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study)

“…The necessity for additional clinical trials specifically focused on unraveling the optimal use, efficacy and safety of furosemide in AKI stems from an apparent disconnect in the widespread utilization of furosemide in practice juxtaposed with evidence suggestive of no clinical benefit and potential harm [5,[31][32][33]. Early clinical trials of furosemide use in AKI were small, confounded by co-interventions (i.e., mannitol, dopamine), characterized by late administration…”

“…Observational studies detailing the risk of furosemide for development of AKI or poor outcome associated with its use are almost certainly susceptible to confounding by indication [5,33]. In these studies, the risk of death or non-recovery was predominantly borne by patients with more severe oliguric AKI who did not show a robust response to initial diuretic challenge.…”

The hemodynamic effects during sustained low-efficiency dialysis versus continuous veno-venous hemofiltration for uremic patients with brain hemorrhage: a crossover study

“…The inclusion criteria were anuric ESRD patients undergoing chronic dialysis for at least 3 months and who had increased ICP and underwent ICP monitoring after brain injury. Those with active brain hemorrhage, cardiac arrhythmia during dialysis, and an inotropic equivalent 41 of more than 15 were excluded. Before patients were enrolled, they received CVVH, which is generally thought to be optimal to maintain brain hemodynamics.…”