title: Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.
abstract: BACKGROUND
  The impact of diuretic usage and dosage on the mortality of critically ill patients with acute kidney injury is still unclear.
  
  
  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
  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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Chun-Fu
authors.initials: CF
authors.lastname: Lai
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Shiao
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Wu
authors.forename: Chia-Ter
authors.initials: CT
authors.lastname: Chao
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Tao-Min
authors.initials: TM
authors.lastname: Huang
authors.forename: Yu-Chang
authors.initials: YC
authors.lastname: Yeh
authors.forename: I-Jung
authors.initials: IJ
authors.lastname: Tsai
authors.forename: Tze-Wah
authors.initials: TW
authors.lastname: Kao
authors.forename: Yin-Yi
authors.initials: YY
authors.lastname: Han
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Wu
authors.forename: Chun-Cheng
authors.initials: CC
authors.lastname: Hou
authors.forename: Guang-Huar
authors.initials: GH
authors.lastname: Young
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.forename: Tun-Jun
authors.initials: TJ
authors.lastname: Tsai
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D016638:Critical Illness / Q000401:mortality*; D003710:Demography; D004232:Diuretics / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D004232:Diuretics