{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T04:20:41Z","timestamp":1788841241229,"version":"build-2803163510"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2019,1]]},"abstract":"\n Background and objectives<\/jats:title>\n Loop diuretics are commonly used to manage nondialysis-dependent CKD. Despite benefits of augmented urine output, loop diuretics are often discontinued after dialysis initiation. Here, we assessed the association of the early decision to continue loop diuretics at hemodialysis start with clinical outcomes during the first year of dialysis.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n We considered all patients on in-center hemodialysis at a large dialysis organization (2006\u20132013) with Medicare Part A and D benefits who had an active supply of a loop diuretic at dialysis initiation (\n n<\/jats:italic>\n =11,297). Active therapy was determined on the basis of whether loop diuretic prescription was refilled after dialysis initiation and within 30 days of exhaustion of prior supply. Patients were followed under an intention-to-treat paradigm for up to 12 months for rates of death, hospitalization, and intradialytic hypotension and mean monthly values of interdialytic weight gain, serum potassium, predialysis systolic BP, and ultrafiltration rates.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We identified 5219 patients who refilled a loop diuretic and 6078 eligible controls who did not. After adjustments for patient mix and clinical differences, continuation of loop diuretics was associated with lower hospitalization (adjusted incidence rate ratio, 0.93; 95% confidence interval, 0.89 to 0.98) and intradialytic hypotension (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.92 to 0.99) rates, no difference in death rate (adjusted hazard ratio, 0.92; 95% confidence interval, 0.84 to 1.01), and lower interdialytic weight gain (\n P<\/jats:italic>\n =0.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Continuation of loop diuretics after hemodialysis initiation was associated with lower rates of hospitalization and intradialytic hypotension as well as lower interdialytic weight gain, but there was no difference in mortality over the first year of dialysis.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.05080418","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T15:05:13Z","timestamp":1545231913000},"page":"95-102","source":"Crossref","is-referenced-by-count":66,"title":["Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes"],"prefix":"10.2215","volume":"14","author":[{"given":"Scott","family":"Sibbel","sequence":"first","affiliation":[{"name":"DaVita Clinical Research, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam G.","family":"Walker","sequence":"additional","affiliation":[{"name":"DaVita Clinical Research, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carey","family":"Colson","sequence":"additional","affiliation":[{"name":"DaVita Clinical Research, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Tentori","sequence":"additional","affiliation":[{"name":"DaVita Clinical Research, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Brunelli","sequence":"additional","affiliation":[{"name":"DaVita Clinical Research, Minneapolis, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Flythe","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina; and"},{"name":"Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,12,19]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1053\/j.ajkd.2006.12.012","article-title":"Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS).","volume":"49","author":"Bragg-Gresham","year":"2007","journal-title":"Am J Kidney Dis"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/sdi.12483","article-title":"Are diuretics underutilized in dialysis patients?","volume":"29","author":"Trinh","year":"2016","journal-title":"Semin Dial"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1111\/j.1525-139X.2011.00927.x","article-title":"Should high-dose oral diuretics be used to increase urine output in patients on chronic peritoneal and hemodialysis?","volume":"24","author":"Fissell","year":"2011","journal-title":"Semin Dial"},{"key":"B4-20230813","first-page":"40","article-title":"Effectiveness of furosemide in patients on peritoneal dialysis.","volume":"16","author":"Flinn","year":"2006","journal-title":"CANNT J"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1046\/j.1523-1755.2001.0590031128.x","article-title":"Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis.","volume":"59","author":"Medcalf","year":"2001","journal-title":"Kidney Int"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1056\/NEJMoa021583","article-title":"Effect of dialysis dose and membrane flux in maintenance hemodialysis.","volume":"347","author":"Eknoyan","year":"2002","journal-title":"N Engl J Med"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/aje\/kwv214","article-title":"Counterpoint: The treatment decision design.","volume":"182","author":"Brookhart","year":"2015","journal-title":"Am J Epidemiol"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/pds.1357","article-title":"Immortal time bias in observational studies of drug effects.","volume":"16","author":"Suissa","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1681\/ASN.2014020222","article-title":"Association of mortality risk with various definitions of intradialytic hypotension.","volume":"26","author":"Flythe","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies.","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/EDE.0b013e3181a819a1","article-title":"Overadjustment bias and unnecessary adjustment in epidemiologic studies.","volume":"20","author":"Schisterman","year":"2009","journal-title":"Epidemiology"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"409","DOI":"10.2215\/CJN.05070511","article-title":"Risks of subsequent hospitalization and death in patients with kidney disease.","volume":"7","author":"Daratha","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1681\/ASN.V12102158","article-title":"Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: A reanalysis of the CANUSA study.","volume":"12","author":"Bargman","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1053\/j.ajkd.2010.03.020","article-title":"Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: The Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study.","volume":"56","author":"Shafi","year":"2010","journal-title":"Am J Kidney Dis"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1038\/sj.ki.5000382","article-title":"The importance of residual renal function in dialysis patients.","volume":"69","author":"Wang","year":"2006","journal-title":"Kidney Int"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"2978","DOI":"10.1093\/ndt\/gfq856","article-title":"Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model.","volume":"26","author":"van der Wal","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1056\/NEJMoa1001593","article-title":"In-center hemodialysis six times per week versus three times per week.","volume":"363","author":"Chertow","year":"2010","journal-title":"N Engl J Med"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1258\/acb.2011.011281","article-title":"Diuretics: A review.","volume":"49","author":"Wile","year":"2012","journal-title":"Ann Clin Biochem"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/j.1749-6632.1999.tb00278.x","article-title":"Insights into ototoxicity. Analogies to nephrotoxicity.","volume":"884","author":"Humes","year":"1999","journal-title":"Ann N Y Acad Sci"},{"key":"B22-20230813","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1159\/000446449","article-title":"Furosemide increases the risk of hyperparathyroidism in chronic kidney disease.","volume":"43","author":"Vasco","year":"2016","journal-title":"Am J Nephrol"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1093\/ndt\/gfr026","article-title":"Diuretics, calciuria and secondary hyperparathyroidism in the Chronic Renal Insufficiency Cohort.","volume":"26","author":"Isakova","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1001\/jamainternmed.2014.5857","article-title":"Association of loop diuretic use with higher parathyroid hormone levels in patients with normal renal function.","volume":"175","author":"Corapi","year":"2015","journal-title":"JAMA Intern Med"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1093\/oxfordjournals.ndt.a091995","article-title":"Frusemide therapy and intact parathyroid hormone plasma concentrations in chronic renal insufficiency.","volume":"7","author":"Reichel","year":"1992","journal-title":"Nephrol Dial Transplant"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1056\/NEJM199808063390607","article-title":"Diuretic therapy.","volume":"339","author":"Brater","year":"1998","journal-title":"N Engl J Med"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201901000-00015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:59Z","timestamp":1786369019000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201901000-00015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,19]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.05080418","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,19]]}}}