title: Diuretics, Limited Ultrafiltration, and Residual Renal Function in Incident Hemodialysis Patients: A Case Series.
abstract: The effect of diuretics on residual renal function expressed as residual GFR (rGFR) and urine volume (rUV) using 24-hour urine collections has not been well examined in hemodialysis (HD) patients. We present a small (seven patient) but provocative case series describing a strikingly low rate of decline in rUV and rGFR (average of creatinine and urea clearances, 24-hour urine collections) in patients treated with increasing doses of furosemide (up to 360 mg/day) during the first 2 years after initiation of HD. Between 6 and 12 months, the mean rUV fell by 1 ml/month, whereas rGFR declined by 0.03 ml/min/1.73 m(2) /month. The mean rate of decline from 12 to 24 months for rUV (33 ml/month) and rGFR (0.02 ml/min/1.73 m(2) /month) were also low. While data are clearly limited and the observation retrospective, they are consistent with the better documented benefit of diuretics observed in end-stage renal disease patients treated with peritoneal dialysis.
authors.affiliation: The Sahlgrenska Academy School of Medicine, Gothenburg University, Gothenburg, Sweden.
authors.forename: Jessica
authors.initials: J
authors.lastname: Sjolund
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Desiree
authors.initials: D
authors.lastname: Garcia Anton
authors.affiliation: Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Liz Y
authors.initials: LY
authors.lastname: Bayes
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Tiny
authors.initials: T
authors.lastname: Hoekstra
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Division of Nephrology, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida. jmmendoza@med.miami.edu.
authors.forename: Jair
authors.initials: J
authors.lastname: Munoz Mendoza
mesh_terms: D000328:Adult; D000368:Aged; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014462:Ultrafiltration
chemical_list: D004232:Diuretics