TY - JOUR
T1 - Efficacy of loop diuretics in the management of undocumented patients with end-stage renal disease
AU - Ahmed, Salman
AU - Guffey, Danielle
AU - Minard, Charles
AU - Workeneh, Biruh
N1 - Funding Information:
This study was funded in part by the Selzman Institute for Kidney Health, Baylor College of Medicine , Houston, Texas.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - An estimated 6000 patients who are undocumented immigrants have end-stage renal disease (ESRD) and routinely present to public safety-net hospitals for life-saving emergent dialysis treatments. Because these patients lack a dialysis unit, they often do not have access to medication management consistently coordinated by a nephrologist, and this can result in more frequent emergency department (ED) utilization and cost of care. We hypothesized that patients who were taking loop diuretics had fewer ED visits for emergency dialysis. Loop diuretics can potentially take advantage of residual renal function and mitigate excess fluid gain that can induce heart failure and high potassium, the two most common indications for emergency dialysis. In our univariable analysis, patients on furosemide had 3.1 fewer ED visits on average compared with patients who are not on furosemide. After adjusting for vintage and serum potassium measures, the average number of ED visits was about 1.1 visits less in furosemide-treated patients compared with patients not receiving furosemide (95% confidence interval, − 4.4 to 2.1). These results suggest that loop diuretics may have an important role in undocumented patients with ESRD with residual renal function. Further study to develop practical approaches to the care of undocumented patients with ESRD is greatly needed.
AB - An estimated 6000 patients who are undocumented immigrants have end-stage renal disease (ESRD) and routinely present to public safety-net hospitals for life-saving emergent dialysis treatments. Because these patients lack a dialysis unit, they often do not have access to medication management consistently coordinated by a nephrologist, and this can result in more frequent emergency department (ED) utilization and cost of care. We hypothesized that patients who were taking loop diuretics had fewer ED visits for emergency dialysis. Loop diuretics can potentially take advantage of residual renal function and mitigate excess fluid gain that can induce heart failure and high potassium, the two most common indications for emergency dialysis. In our univariable analysis, patients on furosemide had 3.1 fewer ED visits on average compared with patients who are not on furosemide. After adjusting for vintage and serum potassium measures, the average number of ED visits was about 1.1 visits less in furosemide-treated patients compared with patients not receiving furosemide (95% confidence interval, − 4.4 to 2.1). These results suggest that loop diuretics may have an important role in undocumented patients with ESRD with residual renal function. Further study to develop practical approaches to the care of undocumented patients with ESRD is greatly needed.
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U2 - 10.1016/j.ajem.2016.05.042
DO - 10.1016/j.ajem.2016.05.042
M3 - Article
C2 - 27260551
AN - SCOPUS:84973539370
SN - 0735-6757
VL - 34
SP - 1552
EP - 1555
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
IS - 8
ER -