Effect of diuretic and ultrafiltration on edema and renal residual function in peritoneal dialysis patients

Objectives: To compare the effect of diuretic and ultrafiltration on edema and residual function in peritoneal patients. Methods: Fifty-two peritoneal dialysis patients treated for more than 3 months in a single center were involved in this retrospective study. Those patients who suffered from mild or moderate edema and produced more than 400 ml of urine per day were divided into a diuretic group (26 cases) and a control group (26 cases). The diuretic group received oral furosemide 120 mg per day with original peritoneal dialysis prescription, and the control group received high glucose (2.5% or 4.25%) dialysate. Volume marks, biochemical index, sodium excretion, decline of glomerular filtration rate changes, and dialysis prescription were compared between the two groups after 6 months intervention. Results: After 6 months intervention, the proportions of edema in the two groups were all obviously improved (P<0.01) with significant weight loss (P<0.05) and satisfying blood pressure control (P<0.05). The patients in the diuretic group achieved higher urine volume (P<0.01), less dialysis ultrafiltration (P<0.01), and higher urine sodium excretion (P<0.01) than the patients in the control group. The decline speed of glomerular filtration rate (GFR) in the diuretic group was markedly slower than that in the control group (P<0.05). There were no significant differences in peritoneal dialysate sodium excretion, blood pressure, and in blood urea nitrogen, creatinine, albumin, and hemoglobin levels between the two groups after 6 months intervention. However, the blood glucose concentration was much higher in the control group than in the diuretic group (P<0.05), at least partly because of higher concentrations of dialysis fluid glucose (P<0.05). Conclusions: Furosemide may help protect residual renal function by reducing hypotensive episodes during dialysis with a lesser incidence of hypokalemia, hypoproteinemia, hypotension, and glucose metabolic disturbance than hyperosmotic dialysate.