Effectiveness of furosemide in patients on peritoneal dialysis.
BACKGROUND
Residual renal function (RRF) is a marker for a good index of health and is associated with improved survival for individuals with end stage renal disease on peritoneal dialysis. As RRF declines with time on dialysis, fluid balance is more difficult to achieve. Urine output plays a vital role in fluid removal and it has been postulated that loop diuretics improve diuresis in peritoneal dialysis (PD) patients. The aim of this study is to evaluate our use of furosemide and its effect on diuresis in a home peritoneal dialysis program.


METHODS
Sixty-one patients met inclusion criteria of having been on PD continuously for one year from their start date with complete 24-hour urine kinetics. Twenty patients were on furosemide and 41 patients were in the control group. Data for urine volume (UV), serum creatinine (SCr), total and residual creatinine clearance (CrCl(total) and CrCl(residual)), total and residual urea clearance (Kt/V(total) and Kt/V(residual)) and dry body weight were collected at baseline, six months and one year. The average change in UV CrCl(total), and Kt/V(total) from baseline at six and 12 months and the proportion of patients who developed anuria at one year were determined.


RESULTS
UV declined in the furosemide and control groups at six months by an average of 78.00 +/- 445.2 mL/day and 105.5 +/- 401.8 mL/day (p=0.8) and at 12 months by 85.00 +/- 481.7 mL/day and 110.7 +/- 455.4 mL/day (p=0.8), respectively. CrCl declined in the furosemide and control groups at six months by an average of 5.55 +/- 20.4 mL/min and 4.52 +/- 29.0 mL (p=0.9), and at 12 months by 3.95 +/- 35.5 mL/min and 9.05 +/- 28.4 mL/min (p = 0.5) respectively. Kt/V increased by 0.0850 +/- 0.890 in the furosemide group and declined by 0.0456 +/- 0.614 in the control group at six months (p=0.5), but after 12 months, Kt/V declined in both the furosemide and control groups by 0.00400 +/- 0.565 and 0.162 +/- 0.558 (p=0.5) respectively. Only one patient (five per cent) in the furosemide group developed anuria after one year on PD, whereas nine patients (22%) in the control group became anuric (p=0.1).


CONCLUSIONS
Furosemide did not have a statistically significant effect in either improving UV or preserving RRF in patients on PD for one year, but this study was not adequately powered to show an association. Although not statistically significant, fewer patients were anuric at one year in the furosemide group (five per cent versus 22%). Furosemide was not shown to be detrimental to either RRF or UV.
Flinn
Amy
A
Acute Care of the Elderly, London Health Sciences Centre, London, Ontario. amy.flinn@lhsc.on.ca
Ledger
Séadna
S
Blake
Peter
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001002:Anuria / Q000209:etiology; D001806:Blood Urea Nitrogen; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D004232:Diuretics / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D005665:Furosemide / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009864:Ontario; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
D004232:Diuretics; D005665:Furosemide; D003404:Creatinine