Department of Nephrology, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67 000, Strasbourg, France.
Pôle Santé Atlantique-Association ECHO, Avenue Claude Bernard, 44800, Saint-Herblain, France.
J Nephrol. 2023 Sep;36(7):2047-2056. doi: 10.1007/s40620-023-01752-3. Epub 2023 Sep 28.
Diuretics can reduce fluid overload but their effects on conditions of dialysis start remain elusive. We aimed to determine whether loop diuretics exposure in the year before inception can delay the need for dialysis, affect the conditions of dialysis start, and cause early mortality three months after initiation in pre-dialysis patients.
All adult patients starting dialysis from 2009 to 2015 in the REIN registry were included. Three subgroups were defined according to diuretics exposure: "continuous", "stopped", or "no diuretics" over the year before inception and compared for pre-dialysis hospitalization rates, and 3-month mortality after dialysis.
Among 59,302 patients, we found fewer emergency initiations of dialysis in the continuous diuretics group than in the stopped diuretics and no diuretics groups: 9492 (27.5%) vs 1905 (32.3%) and 5226 (35.0%), respectively; p < 0.0001. In the continuous diuretics group, there were fewer starts on central venous catheters than in the stopped diuretics and no diuretics groups: 16,677 (49.4%) vs. 3246 (56.0%) vs. 8,639 (58.4%); p < 0.0001. Patients with continuous diuretic exposure had a lower hospitalization rate than the stopped diuretics group in the year prior to dialysis, except for heart failure. The unadjusted 3-month hazard ratio of mortality after dialysis inception was significantly higher in the "no diuretics" or "stopped diuretics" groups compared with "continuous diuretics", but the excess of risk was blunted after adjustment for emergency start and pre-dialysis visits to a nephrologist.
Continuous loop diuretics exposure in the year before dialysis was associated with better conditions of dialysis inception, and possibly lower mortality rates in the three months after inception.
利尿剂可以减少液体超负荷，但它们对透析开始时的情况的影响仍不清楚。我们旨在确定在透析前患者中，在开始前的一年中使用袢利尿剂是否可以延迟透析的需要，影响透析开始的条件，并在透析开始后三个月导致早期死亡。
纳入了 2009 年至 2015 年在 REIN 登记处开始透析的所有成年患者。根据利尿剂暴露情况将患者分为三组：在开始前一年中持续、停止或无利尿剂，并比较透析前住院率和透析后三个月的死亡率。
在 59302 例患者中，我们发现连续使用利尿剂组的紧急透析开始人数少于停止使用利尿剂组和无利尿剂组：9492（27.5%）与 1905（32.3%）和 5226（35.0%）相比；p<0.0001。在连续使用利尿剂组中，与停止使用利尿剂组和无利尿剂组相比，中心静脉导管开始使用的人数更少：16677（49.4%）与 3246（56.0%）和 8639（58.4%）相比；p<0.0001。与停止使用利尿剂组相比，在透析前一年中持续使用利尿剂的患者除心力衰竭外，住院率较低。与“无利尿剂”或“停止利尿剂”组相比，“持续利尿剂”组在透析开始后三个月的死亡率无调整风险比显著较高，但在调整紧急开始和透析前到肾病医生就诊后，风险增加幅度减弱。
在透析前一年中持续使用袢利尿剂与更好的透析开始条件相关，并且可能在透析开始后三个月内死亡率降低。
