Description:
Abstract BACKGROUND AND AIMS Loop diuretic use during maintenance haemodialysis (HD), including use of very high doses in Europe, is thought to maintain diuresis and reduce interdialytic weight gain, but is based on little evidence, with impact on clinical outcomes unclear. To help better inform international therapeutic strategies, we investigate regional variation in loop diuretic use and dosing strategies. METHOD This study included 71 756 HD patients from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 2–5 (2002–15), including 27 759 patients with dialysis vintage (time since HD initiation) <1 year. We report the proportion of patients in each country prescribed a diuretic (loop, thiazide or other) by dialysis vintage. Among patients with vintage < 1 year at enrollment and prescribed a loop diuretic, we report the distribution of loop diuretic dose (mg/day) by country. Doses of torsemide (4:1) and bumetanide (80:1) were converted to oral furosemide-equivalent dose. RESULTS Diuretic use varied widely by country, ranging at vintage < 3 months from >80% in Germany and Sweden to < 35% in the US, Spain, and Gulf Cooperation Council (GCC) countries (Figure 1). The proportion of patients prescribed a diuretic decreased with dialysis vintage in all countries. At vintage >5 years, diuretic use was 30%–35% in Germany and Sweden and < 20% in other countries. In all countries, >90% of diuretic prescriptions were for loop diuretics. Loop diuretic dose varied widely across countries. Among patients with vintage < 1 year, median dose ranged from 400–500 mg/day in Belgium, France, Germany and Sweden to < 100 mg/day in the GCC, Japan, Spain and the US (Figure 2). CONCLUSION We observed substantial international differences in diuretic prescription patterns to HD patients, with usage and doses much higher in some European countries than the US, where high-dose formulations are not available. The potential impact of diuretic prescription patterns on outcomes, including residual urine volume, volume-related complications and others should be investigated.