title: Diuretics prescribing in chronic kidney disease patients: physician assessment versus bioimpedence spectroscopy.
abstract: BACKGROUND
  The relationship between hypertension and fluid overload in pre-dialysis CKD patients need to be elucidated. Current study aimed to find relationship between fluid overload and hypertension along with prescribed diuretic therapy using bioimpedance spectroscopy (BIS).
  
  
  METHODS
  A prospective observational study was conducted by inviting pre-dialysis CKD patients. Fluid overload was assessed by BIS.
  
  
  RESULTS
  A total of 312 CKD patients with mean eGFR 24.5 ± 11.2 ml/min/1.73 m2were enrolled. Based on OH value ≥7 %, 135 (43.3 %) patients were hypervolemic while euvolemia was observed in 177 (56.7 %) patients. Patients were categorized in different regions of hydration reference plot (HRP) generated by BIS i.e., 5.1 % in region-N (normal BP and fluid status), 20.5 % in region I (hypertensive with severe fluid overload), 29.5 % in region I-II (hypertensive with mild fluid overload), 22 % in region II (hypertensive with normohydration), 10.2 % in region III (underhydration with normal/low BP) and 12.5 % in region IV (normal BP with severe fluid overload). A total of 144 (46 %) patients received diuretics on basis of physician assessment of BP and edema. Maximum diuretics 100 (69.4 %) were prescribed in patients belonging to regions I and I-II of HRP. Interestingly, a similar number of diuretic prescriptions were observed in region II (13 %) and region IV (12 %). Surprisingly, 7 (4.9 %) of patients in region III who were neither hypervolemic nor hypertensive were also prescribed with diuretics.
  
  
  CONCLUSIONS
  BIS can aid clinicians to categorize CKD patients on basis of their fluid status and provide individualized pharmacotherapy to manage hypertensive CKD patients.
authors.affiliation: School of Pharmaceutical Sciences, University Sains Malaysia, 11800, Penang, Malaysia. yusrahabib@ymail.com.|Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia. yusrahabib@ymail.com.
authors.forename: Yusra Habib
authors.initials: YH
authors.lastname: Khan
authors.affiliation: School of Pharmaceutical Sciences, University Sains Malaysia, 11800, Penang, Malaysia.
authors.forename: Azmi
authors.initials: A
authors.lastname: Sarriff
authors.affiliation: Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
authors.forename: Azreen Syazril
authors.initials: AS
authors.lastname: Adnan
authors.affiliation: School of Pharmaceutical Sciences, University Sains Malaysia, 11800, Penang, Malaysia.
authors.forename: Amer Hayat
authors.initials: AH
authors.lastname: Khan
authors.affiliation: School of Pharmaceutical Sciences, University Sains Malaysia, 11800, Penang, Malaysia.|Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, University Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
authors.forename: Tauqeer Hussain
authors.initials: TH
authors.lastname: Mallhi
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D001823:Body Composition / Q000187:drug effects*; D058266:Dielectric Spectroscopy; D004231:Diuresis / Q000187:drug effects*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions; D017097:Electric Impedance; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects*; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D004232:Diuretics
keywords: Bioimpedance spectroscopy; Chronic kidney disease; Diuretics; Fluid overload; Prescribing