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Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

Wu VC, Lai CF, Shiao CC, Lin YF, Wu PC, Chao CT, Hu FC, Huang TM, Yeh YC, Tsai IJ, Kao TW, Han YY, Wu WC, Hou CC, Young GH, Ko WJ, Tsai TJ, Wu KD - PLoS ONE (2012)

Bottom Line: Higher 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT

Background: The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.

Methods and results: In 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 PaO(2)/FiO(2) (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 significance: Higher 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.

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Related in: MedlinePlus

Accumulated diuretics related to blood pressure.The smoothed plot of a generalized additive model for the relationship between time-varying three-day accumulative diuretic dose and blood pressure difference in post-surgical dialysis patients with adjustments for possible linear and nonlinear effects* (p<0.001).
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pone-0030836-g004: Accumulated diuretics related to blood pressure.The smoothed plot of a generalized additive model for the relationship between time-varying three-day accumulative diuretic dose and blood pressure difference in post-surgical dialysis patients with adjustments for possible linear and nonlinear effects* (p<0.001).

Mentions: To examine the effect of diuretic use and decrease the residual confounding factors (e.g., fluid overload, oliguria, and tissue hypoxia), daily variable factors (body weight, urine output, mean blood pressure, PaO2/FiO2, lactate, BUN, and creatinine) were correlated to the time-varying three-day accumulative diuretic dose, as shown in the GEE model, and plotted by smoothed GAM plot after adjusting for all the covariates listed in Table 1. Diuretic use was significantly associated with the intensity of dialysis (p<0.001) (Table S1) and daily mean blood pressure (p<0.001) (Table S2 and Figure 4), but not with daily PaO2/FiO2 (p = 0.293), lactate (p = 0.948), BUN (p = 0.905), body weight (p = 0.449), creatinine (p = 0.653), and urine output (p = 0.075).


Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.

Wu VC, Lai CF, Shiao CC, Lin YF, Wu PC, Chao CT, Hu FC, Huang TM, Yeh YC, Tsai IJ, Kao TW, Han YY, Wu WC, Hou CC, Young GH, Ko WJ, Tsai TJ, Wu KD - PLoS ONE (2012)

Accumulated diuretics related to blood pressure.The smoothed plot of a generalized additive model for the relationship between time-varying three-day accumulative diuretic dose and blood pressure difference in post-surgical dialysis patients with adjustments for possible linear and nonlinear effects* (p<0.001).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3303770&req=5

pone-0030836-g004: Accumulated diuretics related to blood pressure.The smoothed plot of a generalized additive model for the relationship between time-varying three-day accumulative diuretic dose and blood pressure difference in post-surgical dialysis patients with adjustments for possible linear and nonlinear effects* (p<0.001).
Mentions: To examine the effect of diuretic use and decrease the residual confounding factors (e.g., fluid overload, oliguria, and tissue hypoxia), daily variable factors (body weight, urine output, mean blood pressure, PaO2/FiO2, lactate, BUN, and creatinine) were correlated to the time-varying three-day accumulative diuretic dose, as shown in the GEE model, and plotted by smoothed GAM plot after adjusting for all the covariates listed in Table 1. Diuretic use was significantly associated with the intensity of dialysis (p<0.001) (Table S1) and daily mean blood pressure (p<0.001) (Table S2 and Figure 4), but not with daily PaO2/FiO2 (p = 0.293), lactate (p = 0.948), BUN (p = 0.905), body weight (p = 0.449), creatinine (p = 0.653), and urine output (p = 0.075).

Bottom Line: Higher 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

ABSTRACT

Background: The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.

Methods and results: In 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 PaO(2)/FiO(2) (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 significance: Higher 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.

Show MeSH
Related in: MedlinePlus