• Plos One · Jan 2012

    Multicenter Study

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

    • Vin-Cent Wu, Chun-Fu Lai, Chih-Chung Shiao, Yu-Feng Lin, Pei-Chen Wu, Chia-Ter Chao, Fu-Chang Hu, Tao-Min Huang, Yu-Chang Yeh, I-Jung Tsai, Tze-Wah Kao, Yin-Yi Han, Wen-Chung Wu, Chun-Cheng Hou, Guang-Huar Young, Wen-Je Ko, Tun-Jun Tsai, and Kwan-Dun Wu.
    • Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
    • Plos One. 2012 Jan 1;7(3):e30836.

    BackgroundThe impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.Methods And ResultsIn 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 SignificanceHigher 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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