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Abstract: PO1150

The Use of Loop Diuretics in Newly Initiated Hemodialysis Patients: The Clinician's Perspective

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kaur, Tripta, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Nadkarni, Girish N., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

ESRD patients newly initiated on HD have varying levels of residual renal function (RRF). The loss of RRF is associated with increased cardiovascular and all-cause mortality and decreased quality of life (QOL). There are no studies reported to date that have explored in detail the physicians' clinical opinion and approach to the use of diuretics after the initiation of HD.

Methods

A one-time anonymous electronic survey was created to explore the clinicians’ opinion and practice pattern of diuretic use in new-start HD patients. 50 nephrologists associated with the Mount Sinai Health System were included.

Results

23 (46%) completed the survey and 8 (35%) have practiced nephrology for > 15-years. 16 (70%) assess RRF monthly. The level of urine output per day (UOP/d) considered adequate for diuretic use was 200-250 mL by 7 (30%) and 400-500 mL by 12 (52%). While 20 (87%) and 18 (78%) of the physicians felt that diuretics are effective in HD patients and improve quality of life (QOL), respectively, only 5 (22%) always continue diuretics and 13 (57%) sometimes start diuretics after initiation of HD (Fig 1). Physicians with >15 years in practice were more likely to continue diuretics than physicians with less experience (50% vs. 7%, P=0.03). Volume status (70%) and the ineffectiveness of diuretics (64%) were considered more important factors in the decision to use diuretics. Only 5 (26%) routinely use furosemide > 240 mg/day, but only 10 (43%) were influenced by ototoxicity.

Conclusion

While a majority of physicians believe that diuretics are effective and improve patient QOL, few consistently continued diuretics and only half started diuretics “sometimes”. The factors that were considered more important in decisions to continue or start diuretics were volume status and the opinion that diuretics can be ineffective in HD patients.