OBJECTIVES: Fluid overload is a major presentation in late chronic kidney disease (CKD) patients and is frequently present in mild to moderate CKD cases. Abnormal fluid status has been associated with hypertension, congestive heart failure (CHF), left ventricular hypertrophy (LVH) as well as edema (pulmonary, pedal). Diuretics are frequently prescribed to control blood pressure and symptomatic relief of fluid overload. The clinical assessment of fluid status is relatively difficult and diuretics are mostly prescribed on the basis of high blood pressure and physical signs of edema in clinical settings. Although edema can roughly estimate excess extravascular volume but it is of limited value in assessing excess intravascular volume. Current study was conducted to assess fluid status and prescribing pattern of diuretics among CKD patients.

METHODS: Bioimpedance spectroscopy was used to assess fluid status followed by patient routine visit to consulting physician. Neither patient nor physician was aware of BCM results.

RESULTS: A total of 312 patients with moderate to severe CKD were enrolled. Overall diuretic use was observed in 144 (46%) patients. Out of 144 patients, majority 81 (56%) of the patients were hypervolemic, followed by euvolemic 44 (30.5%) and hypovolemic 19(13.1%) patients. Loop diuretics were predominantly prescribed in hypervolemic (79%) patients while thiazides were more frequently prescribed in hypovolemic (71%) and euvolemic (68%) patients.

CONCLUSIONS: Our findings suggest inadequate prescribing of diuretics in hypervolemic patients while over prescribing in hypovolemic and euvolemic patients. Implementation of bioimpedance spectroscopy in routine clinical practice is therefore highly recommended.