{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:01:34Z","timestamp":1782284494493,"version":"3.54.5"},"reference-count":40,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T00:00:00Z","timestamp":1643068800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the association between diuretic use by class with chronic kidney disease (CKD) progression and onset of end-stage renal disease (ESRD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Large integrated healthcare delivery system in Northern California.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Adults with an estimated glomerular filtration rate (eGFR) 15\u201359\u2009min\/1.73 m<jats:sup>2<\/jats:sup> by the CKD-Epidemiology Collaboration equation with no prior diuretic use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>ESRD and a renal composite outcome including eGFR &lt;15\u2009mL\/min\/1.73 m<jats:sup>2<\/jats:sup>, 50% reduction in eGFR and\/or ESRD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 47\u2009666 eligible adults with eGFR 15\u201359\u2009min\/1.73 m<jats:sup>2<\/jats:sup> and no previous receipt of loop or thiazide diuretics, mean age was 71 years, 49% were women and 26% were persons of colour. Overall, the rate (per 100 person-years) of the renal composite outcome was 1.35 (95% CI: 1.30 to 1.41) and 0.42 (95% CI: 0.39 to 0.45) for ESRD. Crude rates (per 100 person-years) of the composite renal outcome were higher in patients who initiated loop diuretics (12.85 (95% CI: 11.81 to 13.98) vs 1.06 (95% CI: 1.02 to 1.12)) and thiazide diuretics (2.68 (95% CI: 2.33 to 3.08) vs 1.29 (95% CI: 1.24 to 1.35)) compared with those who did not. Crude rates (per 100-person years) of ESRD where higher in patients who initiated loop diuretics (4.92 (95% CI: 4.34 to 5.59) vs 0.30 (95% CI: 0.28 to 0.33)), but not in those who initiated thiazide diuretics (0.30 (95% CI: 0.20 to 0.46) vs 0.43 (95% CI: 0.40 to 0.46)). However, neither initiation of diuretics or type of diuretic were significantly associated with CKD progression or ESRD after accounting for receipt of other medications and time-dependent confounders using causal inference methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The use of thiazide and loop diuretics was not independently associated with an increased risk of CKD progression and\/or ESRD in adults with stage 3\/4 CKD.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-048755","type":"journal-article","created":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T07:55:16Z","timestamp":1643702116000},"page":"e048755","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Loop and thiazide diuretic use and risk of chronic kidney disease progression: a multicentre observational cohort study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1545-6399","authenticated-orcid":false,"given":"Jesse K","family":"Fitzpatrick","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingrong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P","family":"Ambrosy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2778-1604","authenticated-orcid":false,"given":"Claudia","family":"Cabrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bergur V","family":"Stefansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J","family":"Greasley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jignesh","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thida C","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S","family":"Go","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"key":"2022063004200983000_12.1.e048755.1"},{"key":"2022063004200983000_12.1.e048755.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005480"},{"key":"2022063004200983000_12.1.e048755.3","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2002.32799"},{"key":"2022063004200983000_12.1.e048755.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041031"},{"key":"2022063004200983000_12.1.e048755.5","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2018.12.044"},{"key":"2022063004200983000_12.1.e048755.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2011.09.009"},{"key":"2022063004200983000_12.1.e048755.7","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(82)90854-3"},{"key":"2022063004200983000_12.1.e048755.8","doi-asserted-by":"publisher","DOI":"10.1080\/08860220701641777"},{"key":"2022063004200983000_12.1.e048755.9","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1590\/S0100-879X2012007500093","article-title":"Furosemide is associated with acute kidney injury in critically ill patients","volume":"45","author":"Levi","year":"2012","journal-title":"Braz J Med Biol Res"},{"key":"2022063004200983000_12.1.e048755.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159335","article-title":"Chronic kidney disease, fluid overload and diuretics: a complicated triangle","volume":"11","author":"Khan","year":"2016","journal-title":"PLoS One"},{"key":"2022063004200983000_12.1.e048755.11","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/nep.12713","article-title":"Progression and outcomes of non-dialysis dependent chronic kidney disease patients: a single center longitudinal follow-up study","volume":"22","author":"Khan","year":"2017","journal-title":"Nephrology"},{"key":"2022063004200983000_12.1.e048755.12","doi-asserted-by":"crossref","first-page":"253.2","DOI":"10.1136\/ejhpharm-2017-001285","article-title":"Is diuretic use beneficial or harmful for patients with chronic kidney disease?","volume":"24","author":"Khan","year":"2017","journal-title":"Eur J Hosp Pharm"},{"key":"2022063004200983000_12.1.e048755.13","unstructured":"Gordon NP . 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