Kidney Research and Clinical Practice 2019 Mar; 38(1): 108-115  https://doi.org/10.23876/j.krcp.18.0115
Efficacy of triple diuretic treatment in continuous ambulatory peritoneal dialysis patients: A randomized controlled trial
Raweewan Witoon , Somchai Yongsiri, Prapan Buranaburidej, Pacharin Nanna
Division of Nephrology, Department of Medicine, Faculty of Medicine, Burapha University, Chonburi, Thailand
Correspondence to: Raweewan Witoon, Division of Nephrology, Department of Medicine, Faculty of Medicine, Burapha University, Chonburi 20131, Thailand. E-mail: r_aumy@hotmail.com
ORCID: https://orcid.org/0000-0001-8658-7524
Received: September 18, 2018; Revised: November 23, 2018; Accepted: November 23, 2018; Published online: March 31, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The efficacy of combined diuretic treatment in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is not known.
Methods: In a single-center, double-blinded, randomized controlled trial, we randomly assigned 51 adult CAPD patients to receive furosemide 1,000 mg/day, hydrochlorothiazide 100 mg/day, and spironolactone 50 mg/day (triple diuretics [TD] group) or furosemide 1,000 mg/day plus placebo (single diuretic [SD] group) for 6 months. The primary outcome was the difference in daily urine output at the 3rd and 6th month of the study compared to baseline (ΔUO) between the SD and TD group. Secondary outcomes were urinary sodium (UNa) and potassium (UK) excretion and overhydration (OH) measured by bioimpedance at 3 and 6 months compared to baseline (ΔUNa, ΔUK, and ΔOH, respectively) and daily glucose exposure (g/day).
Results: Forty-three of 51 patients completed the 6-month trial. The ΔUO at 3 and 6 months was significantly higher in the TD group compared to the SD group (386.32 ± 733.92 mL/day vs. -136.25 ± 629.08 mL/day, P < 0.001, at 3 months; 311.58 ± 640.31 mL/day vs. 120.00 ± 624.07 mL/day, P < 0.001, at 6 months) but there was no significant difference in ΔUNa and ΔUK excretion. Hydration status was significantly better in the TD group (ΔOH 1.84 ± 2.27 L vs. 0.44 ± 1.62 L, P = 0.03, at 3 months; 1.49 ± 2.82 L vs. -0.48 ± 2.61 L, P = 0.02, at 6 months). There was no serious adverse event in this study.
Conclusion: For end-stage renal disease patients on CAPD, the combination of furosemide, hydrochlorothiazide, and spironolactone results in higher urine output and better volume control compared to furosemide alone.
Keywords: Furosemide, Hydration status, Hydrochlorothiazide, Peritoneal dialysis, Spironolactone


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