Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis
Journal
PLoS ONE
Journal Volume
7
Journal Issue
3
Pages
e30836
Date Issued
2012
Author(s)
Shiao, Chih-Chung
Wu, Pei-Chen
Hu, Fu-Chang
Kao, Tze -Wah
Wu, Wen-Chung
Hou, Chun-Cheng
Young, Guang-Huar
Ko, Wen-Je
Abstract
Background: The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear. Methods and Results: In 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 Significance: Higher 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. ? 2012 Wu et al.
SDGs
Other Subjects
creatinine; diuretic agent; lactic acid; diuretic agent; acute kidney failure; adult; aged; article; blood oxygen tension; cause of death; controlled study; creatinine blood level; critically ill patient; diabetes mellitus; dialysis; disease association; dose response; female; forced expiratory volume; heart failure; hemodialysis; hospital admission; human; hypotension; intensive care unit; major clinical study; male; mortality; multicenter study; postoperative complication; randomized controlled trial; scoring system; treatment duration; urine volume; blood pressure; clinical trial; critical illness; demography; drug effect; middle aged; mortality; proportional hazards model; prospective study; renal replacement therapy; risk factor; statistical model; survival; time; Blood Pressure; Critical Illness; Demography; Diuretics; Dose-Response Relationship, Drug; Female; Humans; Logistic Models; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Renal Dialysis; Risk Factors; Survival Analysis; Time Factors
Type
journal article