Abstract: TH-PO781

Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Sibbel, Scott, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Walker, Adam G, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Colson, Carey, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Flythe, Jennifer E., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States
Background

Loop diuretics are commonly utilized in the management of non-dialysis dependent chronic kidney disease. Despite potential benefits of augmented urine output, loop diuretics are often discontinued after hemodialysis initiation. In the present study, we assessed the association of the early decision to continue vs discontinue loop diuretics at dialysis start with clinical outcomes during the first year of dialysis.

Methods

This analysis considered all patients who initiated in-center hemodialysis at a large dialysis organization (2007-2013) with Medicare part A & D benefits who had an active supply of loop diuretic at the time of dialysis initiation (N = 11,297). Exposure status was based on whether loop diuretic prescription was refilled after dialysis initiation and within 30 days of exhaustion of prior supply. Patients were followed under an intention-to-treat paradigm for up to 12 months for death, hospitalization, and intradialytic hypotension (IDH).

Results

We identified 5219 patients who refilled a loop diuretic prescription and 6078 eligible controls who did not. After adjustments for case mix and clinical differences, continuation of loop diuretics (vs not) was associated with lower hospitalization (P < 0.001) and IDH (P < 0.001) rates, and a lower death rate which did not achieve statistical significance (P =0.07).

Conclusion

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.

Funding

  • Commercial Support