Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.
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 recrui...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3303770?pdf=render |
| _version_ | 1828409442158247936 |
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| author | Vin-Cent Wu Chun-Fu Lai Chih-Chung Shiao Yu-Feng Lin Pei-Chen Wu Chia-Ter Chao Fu-Chang Hu Tao-Min Huang Yu-Chang Yeh I-Jung Tsai Tze-Wah Kao Yin-Yi Han Wen-Chung Wu Chun-Cheng Hou Guang-Huar Young Wen-Je Ko Tun-Jun Tsai Kwan-Dun Wu |
| author_facet | Vin-Cent Wu Chun-Fu Lai Chih-Chung Shiao Yu-Feng Lin Pei-Chen Wu Chia-Ter Chao Fu-Chang Hu Tao-Min Huang Yu-Chang Yeh I-Jung Tsai Tze-Wah Kao Yin-Yi Han Wen-Chung Wu Chun-Cheng Hou Guang-Huar Young Wen-Je Ko Tun-Jun Tsai Kwan-Dun Wu |
| author_sort | Vin-Cent Wu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T11:54:58Z |
| format | Article |
| id | doaj.art-a8f6f97a1d024b89940ae5d40627d83b |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-10T11:54:58Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a8f6f97a1d024b89940ae5d40627d83b2022-12-22T01:49:49ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0173e3083610.1371/journal.pone.0030836Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis.Vin-Cent WuChun-Fu LaiChih-Chung ShiaoYu-Feng LinPei-Chen WuChia-Ter ChaoFu-Chang HuTao-Min HuangYu-Chang YehI-Jung TsaiTze-Wah KaoYin-Yi HanWen-Chung WuChun-Cheng HouGuang-Huar YoungWen-Je KoTun-Jun TsaiKwan-Dun WuBACKGROUND: 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.http://europepmc.org/articles/PMC3303770?pdf=render |
| spellingShingle | Vin-Cent Wu Chun-Fu Lai Chih-Chung Shiao Yu-Feng Lin Pei-Chen Wu Chia-Ter Chao Fu-Chang Hu Tao-Min Huang Yu-Chang Yeh I-Jung Tsai Tze-Wah Kao Yin-Yi Han Wen-Chung Wu Chun-Cheng Hou Guang-Huar Young Wen-Je Ko Tun-Jun Tsai Kwan-Dun Wu Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis. PLoS ONE |
| title | Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis. |
| title_full | Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis. |
| title_fullStr | Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis. |
| title_full_unstemmed | Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis. |
| title_short | Effect of diuretic use on 30-day postdialysis mortality in critically ill patients receiving acute dialysis. |
| title_sort | effect of diuretic use on 30 day postdialysis mortality in critically ill patients receiving acute dialysis |
| url | http://europepmc.org/articles/PMC3303770?pdf=render |
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