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Kidney Week

ASN / Education & Meetings / Kidney Week /
Abstract: TH-PO1079

Weight-Based Sliding Scale vs. Fixed-Dose Loop Diuretics for Fluid Overload in CKD: A Retrospective Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Aamer, Sameen, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Gardonis, Katelin, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Vavrenyuk, Andrey, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Abd Algayoum, Randa, Garden City Hospital, Garden City, Michigan, United States
  • Arora, Swati, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
Background

Managing fluid overload in chronic kidney disease (CKD) patients is challenging. Fixed doses of loop diuretics often lead to complications such as frequent hospitalizations due to volume overload or pre-renal acute kidney injury (AKI). While weight-based loop diuretic adjustments have reduced hospitalizations in heart failure patients, this approach has not been specifically studied in CKD patients.

Methods

A single-center retrospective study (n=80) from June 2020 to July 2022 compared clinical outcomes between forty patients on fixed-dose loop diuretics (FDD) and forty on weight-based sliding scale loop diuretics (SSD).

Results

The demographics of both groups were similar, except that SSD patients were older (mean age 64.15 vs. 56.28, p = 0.04) and predominantly white (81%), while FDD patients were more likely to be Black (30%, p = 0.03). Linear modeling revealed that SSD significantly predicted better blood pressure (BP) control, with FDD patients having 7.95 mmHg higher BP (β = 7.95, t(246) = 2.19, p = 0.03). Hierarchical generalized linear modeling showed a 57% variance in volume between groups, with SSD patients being 46% less likely to develop hypervolemia over time (OR = 0.54, 95% CI [0.37, 0.80], p = 0.03) compared to FDD patients, who were 8% less likely to develop hypervolemia over time (OR = 0.92, 95% CI [0.71, 1.20], p = 0.03). Patients on FDD had higher hospitalization rates (43.4%) compared to 18.5% for those on SSD (p = 0.03). Clinical outcomes are shown in Table 1.

Conclusion

This study highlights the benefits of sliding scale loop diuretics for managing fluid overload in CKD patients, leading to fewer hospitalizations and improved volume control over time. Further research is needed to validate and expand upon these findings.