医学
利尿剂
药方
速尿
内科学
血液透析
布美他尼
透析
利尿剂
危险系数
比例危险模型
药理学
置信区间
协同运输机
化学
有机化学
钠
作者
Nahid Tabibzadeh,Dongyu Wang,Angelo Karaboyas,Elke Schaeffner,Stefan H. Jacobson,Almudena Vega,Kosaku Nitta,Brian Bieber,Roberto Pecoits-Filho,Pablo Ureña-Torres
出处
期刊:Ndt Plus
[Oxford University Press]
日期:2024-06-14
摘要
Abstract Background and aims The use of diuretics in patients on hemodialysis (HD) is thought to maintain diuresis. However, this assumption and the optimal dose are based on little scientific evidence, and associations with clinical outcomes are unclear. Methods We reported international variation in diuretic use and loop diuretic dose across 27 759 HD patients with dialysis vintage < 1 year in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2–5 (2002–2015), a prospective cohort study. Doses of torsemide (4:1) and bumetanide (80:1) were converted to oral furosemide-equivalent dose. Adjusted Cox, logistic, and linear regressions were used to investigate the association of diuretic use and dose with outcomes. Results Diuretic utilization varied widely by country at vintage < 3 months, ranging from > 80% in Germany and Sweden to < 35% in the US, at a median dose ranging from 400-500 mg/day in Germany and Sweden to <100 mg/day in Japan and the US. Neither diuretic use nor higher doses were associated with a lower risk of all-cause mortality, or a higher risk of hospitalization for fracture, or elevated PTH levels, but the prescription of higher doses (>200 mg/day) was associated with a higher risk of all-cause hospitalization. Conclusions Substantial international differences exist in diuretic prescription, with usage and doses much higher in some European countries than the US. The prescription and higher doses of loop diuretics was not associated with improved outcomes.
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