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Abstract: PO1304

Quality Improvement Initiative: Suboptimal Utilization of Loop Diuretics in Peritoneal Dialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Al hadhrami, Zeyana, Queen's University, Kingston, Ontario, Canada
  • Ghadieh, Omar M., Queen's University, Kingston, Ontario, Canada
  • Iliescu, Eduard A., Queen's University, Kingston, Ontario, Canada
Background

The prescription of high dose loop diuretics is safe and beneficial for PD patients to increase urine output, control of volume status, and decrease the need for high PD fluid glucose concentrations. The aim of this study is to assess the current state and develop an algorithm for rational diuretic use in PD pts to optimize dose, frequency, and reduce pill count in patients with urine output while reducing diuretics in anuric patients.

Methods

This was a prospective cohort QI initiative in prevalent PD pts. The algorithm considered PD fluid glucose > 1.5 % used, the volume status, current and historical urine volume trend, and clinical assessment. The dosing of loop diuretics was increased in pts with residual urine output > 200 ml/24 hrs when increased ultrafiltration was needed, while diuretics were stopped in anuric pts. The outcomes were the proportion of pts on loop diuretic in those with and without urine, the dose (median total daily, frequency) and the pill count before and 3 months after the intervention. In the algorithm, Furosemide prescriptions of 40 mg tablets were converted to 500 mg tablets divided as needed where possible.

Results

The study included 91 pts, mean age 63 yrs, 45% female, 75% Caucasian, 64% with DM, median time on PD of 1.58 yrs. Furosemide was the only loop diuretic used. At base line median total daily dose was 120 mg, BID 27 %, OD 73 %, and mean pill count was 3.6 pills/day. The proportions of patients prescribed diuretics among those with and without urine output were 54/84 (63%) and 8/17 (47%) respectively. Three months after the intervention the median total daily dose was 240 mg, BID 53 % and OD 47%, mean pill count was 2.96 pills/day, and the proportions of pts on Furosemide for those with and without urine output improved to 85% and 27% respectively (all changes p < 0.05).

Conclusion

This short-term study suggests that QI intervention using an algorithm aimed at optimizing loop diuretic use in PD patients based on PD fluid glucose concentration used, and urine volume can increase the prevalence of diuretic use, increase the single and total daily dose, improve dosing frequency, and reduce pill burden in patients with urine output while reducing unnecessary use in anuric pts. This study is ongoing to examine outcomes of urine volume, glucose load of PD fluid, and electrolytes with the intervention.