Diuretic use, dosing, monitoring varies in US hemodialysis practice
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According to published data, diuretic use, dosing and monitoring varies in United States hemodialysis practice.
“Diuretic use in hemodialysis practice is common in many regions; 45% of European and 48% Japanese patients continue diuretics after hemodialysis initiation. In contrast, diuretic use among United States patients declines after dialysis initiation,” Jennifer E. Flythe, MD, MPH, from the University of North Carolina Kidney Center, and colleagues wrote. “Uncertainty regarding diuretic efficacy and optimal dosing likely contributes to this practice variation. We undertook this study to describe the utilization of oral diuretics among U.S. hemodialysis patients.”
In a cross-sectional analysis, researchers examined 176,448 adults receiving center-based maintenance hemodialysis on July 1, 2018, with continuous Medicare coverage throughout the preceding 180 days. Data were derived from the U.S. Renal Data System.
Using Medicare Part D prescription drug claims, researchers identified diuretic use status and determined the ratio of patients taking a diuretic, overall and by type. Additionally, researchers calculated the daily furosemide-equivalent dose among patients taking a loop diuretic.
Analyses revealed a total of 22,296 patients (13%) were taking a diuretic. Researchers found diuretic users were older, newer to hemodialysis, more likely to be white and had a higher prevalence of cardiovascular conditions compared with patients who didn’t use diuretics. Of those patients, 90% took a loop diuretic, 8% took a thiazide/thiazide-like diuretic, 6% took a potassium-sparing diuretic and less than 1% took a carbonic anhydrase inhibitor.
“Our analysis reveals substantial variation in diuretic use, dosing, and monitoring in U.S. hemodialysis practice. We found that diuretic dosing was particularly variable, with the majority of patients prescribed loop diuretics at furosemide-equivalent doses lower than what is recommended in non-dialysis-dependent chronic kidney disease,” Flythe and colleagues wrote. They added, “While clinicians may monitor urine output by means other than 24-hour urine collections, our findings also suggest the absence of a systematic approach to laboratory-based urine volume monitoring in hemodialysis care. Investigation of the efficacy, safety and optimal dosing of diuretics in individuals with hemodialysis-dependent kidney failure is needed.”
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