Chronic Kidney Disease, Fluid Overload and Diuretics: A Complicated Triangle.
Chronic Kidney Disease, Fluid Overload and Diuretics: A Complicated Triangle.
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DOI：
10.1371/journal.pone.0159335
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Mallhi TH
中科院分区：
文献类型：
--
作者：
Khan YH;Sarriff A;Adnan AS;Khan AH;Mallhi TH
尽管利尿剂在慢性肾脏病（CKD）患者中管理液体超负荷方面具有良好的作用，但其使用与不良肾脏结局相关。目前的研究旨在确定利尿剂治疗后肾脏恶化的程度。对312例非透析依赖性CKD（NDD-CKD）患者进行了为期一年的前瞻性随访。通过生物阻抗谱评估液体超负荷。通过使用慢性肾脏病-流行病学协作组（CKD-EPI）公式，根据血清肌酐值计算GFR估计值（eGFR）。在312例患者中，64例（20.5%）为低血容量，而在113例（36.1%）和135例（43.4%）患者中观察到正常血容量和高血容量。共有144例患者使用利尿剂，其中98例（72.6%）为高血容量，35例（30.9%）为正常血容量，11例（17.2%）为低血容量。随访结束时，整个队列的估计GFR平均下降为-2.5 ± 1.4 ml/min/1.73 m2。利尿剂的使用与eGFR下降显著相关。共有36例（11.5%）患者开始肾脏替代治疗（RRT），利尿剂使用者对RRT的需求更大。在我们的NDD-CKD患者队列中，利尿剂的使用与eGFR下降和RRT启动风险增加所示的不良肾脏结局相关。因此，谨慎地建议谨慎地开利尿剂处方，注意每个患者的获益与危害。
Despite promising role of diuretics to manage fluid overload among chronic kidney disease (CKD) patients, their use is associated with adverse renal outcomes. Current study aimed to determine the extent of renal deterioration with diuretic therapy. A total 312 non-dialysis dependent CKD (NDD-CKD) patients were prospectively followed-up for one year. Fluid overload was assessed via bioimpedance spectroscopy. Estimated GFR (eGFR) was calculated from serum creatinine values by using Chronic Kidney Disease- Epidemiology Collaboration (CKD-EPI) equation. Out of 312 patients, 64 (20.5%) were hypovolemic while euvolemia and hypervolemia were observed in 113 (36.1%) and 135 (43.4%) patients. Overall 144 patients were using diuretics among which 98 (72.6%) were hypervolemic, 35 (30.9%) euvolemic and 11 (17.2%) were hypovolemic. The mean decline in estimated GFR of entire cohort was -2.5 ± 1.4 ml/min/1.73m2 at the end of follow up. The use of diuretics was significantly associated with decline in eGFR. A total of 36 (11.5%) patients initiated renal replacement therapy (RRT) and need of RRT was more profound among diuretic users. The use of diuretics was associated with adverse renal outcomes indicated by decline in eGFR and increasing risk of RRT initiation in our cohort of NDD-CKD patients. Therefore, it is cautiously suggested to carefully prescribe diuretics by keeping in view benefit versus harm for each patient.