Background: The evolution and prognostic impact of loop diuretic efficiency according to chronic kidney disease (CKD) severity is unclear. Methods: This retrospective cohort study includes 783 CKD patients on oral loop diuretic therapy with a 24-h urine collection available. Acute kidney injury and history of renal replacement therapy were exclusion criteria. Patients were stratified according to Kidney Disease Improving Global Outcomes (KDIGO) glomerular filtration rate class. Loop diuretic efficiency was calculated as urine output, natriuresis, and chloruresis, each adjusted for loop diuretic dose, and compared among strata. Risk for onset of dialysis and all-cause mortality was evaluated. Results: Loop diuretic efficiency metrics decreased from KDIGO class IIIB to IV in furosemide users and from KDIGO class IV to V with all loop diuretics (p value #x3c;0.05 for all comparisons). The correlation between loop diuretic efficiency and creatinine clearance was moderate at best (Spearman’s ρ 0.298–0.436; p value #x3c;0.001 for all correlations). During median follow-up of 45 months, 457 patients died (58%) and 63 received kidney transplantation (8%), while dialysis was started before in 328 (42%). All loop diuretic efficiency metrics were significantly and independently associated with both the risk for dialysis and all-cause mortality. In KDIGO class IV/V patients, low loop diuretic efficiency (i.e., urine output adjusted for loop diuretic dose ≤1,000 mL) shortened median time to dialysis with 24 months and median time to all-cause mortality with 23 months. Conclusion: Low loop diuretic efficiency is independently associated with a shorter time to dialysis initiation and a higher risk for all-cause mortality in CKD.
Cardiorenal Med

中文翻译：

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慢性肾脏病的袢利尿效果及预后的测定

背景：根据慢性肾病 (CKD) 严重程度，袢利尿剂效率的演变和预后影响尚不清楚。方法：这项回顾性队列研究包括 783 名接受口服袢利尿剂治疗的 CKD 患者，可收集 24 小时尿液。急性肾损伤和肾脏替代治疗史是排除标准。根据改善肾脏疾病全球预后 (KDIGO) 肾小球滤过率等级对患者进行分层。袢利尿效率计算为尿量、尿钠排泄和绿尿，每一项都根据袢利尿剂剂量进行调整，并在各层之间进行比较。评估了透析开始的风险和全因死亡率。结果：环利尿剂效率指标在呋塞米使用者中从 KDIGO IIIB 级降低到 IV，使用所有环利尿剂从 KDIGO IV 级降低到 V（所有比较的p值 #x3c；0.05）。袢利尿剂效率和肌酐清除率之间的相关性充其量是中等的（Spearman's ρ 0.298–0.436；p值 #x3c;0.001 所有相关性）。在 45 个月的中位随访期间，457 名患者死亡 (58%)，63 名患者接受了肾移植 (8%)，而在 328 名患者 (42%) 之前开始透析。所有循环利尿剂效率指标均与透析风险和全因死亡率显着且独立相关。在 KDIGO IV/V 级患者中，低袢利尿剂效率（即，根据袢利尿剂剂量调整后的尿量≤1,000 mL）将透析的中位时间缩短至 24 个月，将至全因死亡的中位时间缩短至 23 个月。结论：低袢利尿剂效率与更短的透析开始时间和更高的 CKD 全因死亡率风险独立相关。
心肾医学