Mitul Patel1, Kavitha Vellanki1, David J Leehey1, Vinod K Bansal1, Linda Brubaker2,3, Robert Flanigan3, Julia Koval1, Anuradha Wadhwa1, Neelam Balasubramanian4, Jasmin Sandhu4, Holly Kramer5,6. 1. Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. 2. Department of Obstetrics and Gynecology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. 3. Department of Urology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. 4. Clinical Research Office, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. 5. Division of Nephrology, Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA. hkramer@luc.edu. 6. Department of Public Health Sciences, Loyola University Chicago, Stritch School of Medicine, CTRE Bldg 454, 2160 First Avenue, Maywood, IL, 60153, USA. hkramer@luc.edu.
Abstract
PURPOSE: Diuretics remain an important medication for hypertension management among adults with chronic kidney disease (CKD), but diuretics may also worsen urinary symptoms, especially urinary incontinence (UI). This single-center pilot study examined the prevalence of UI among adults age ≥60 years with CKD using diuretics and assessed diuretic avoidance due to urinary symptoms. METHODS: Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) and diuretic use were recruited from outpatient nephrology clinics. Urinary symptoms and diuretic avoidance were assessed using standardized questionnaires. RESULTS: The cohort of 44 women and 54 men had a mean age of 71.8 (8.4) years, and urgency-UI, stress-UI and mixed-UI (the presence of both urgency-UI and stress-UI) were reported by 44.9 % (n = 44), 36.7 % (n = 36) and 26.5 % (n = 26), respectively. Nocturia was noted in 68 % (n = 67). Overall, 15.3 % (6 men and 9 women) reported diuretic avoidance. Avoidance of diuretics was 27.3 % (n = 12), 25.5 % (n = 9) and 34.6 % (n = 9) among participants with urgency-UI, stress-UI and mixed-UI, respectively, while only 6.8 % (n = 3) of participants without any UI reported diuretic avoidance. After adjusting for age, sex and diuretic type (loop vs. others), both urgency-UI (odds ratio 5.9 95 % CI 1.5-22.8) and mixed-UI (odds ratio 5.7; 95 % CI 1.6-19.9) were significantly associated with diuretic avoidance compared to participants without urgency-UI, or mixed-UI, respectively. Stress-UI and nocturia were not significantly associated with diuretic avoidance. CONCLUSIONS: UI is common among older adults with CKD receiving diuretics. Patients with urgency-UI are more likely to avoid diuretics.
PURPOSE: Diuretics remain an important medication for hypertension management among adults with chronic kidney disease (CKD), but diuretics may also worsen urinary symptoms, especially urinary incontinence (UI). This single-center pilot study examined the prevalence of UI among adults age ≥60 years with CKD using diuretics and assessed diuretic avoidance due to urinary symptoms. METHODS:Patients with non-dialysis-dependent CKD (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) and diuretic use were recruited from outpatient nephrology clinics. Urinary symptoms and diuretic avoidance were assessed using standardized questionnaires. RESULTS: The cohort of 44 women and 54 men had a mean age of 71.8 (8.4) years, and urgency-UI, stress-UI and mixed-UI (the presence of both urgency-UI and stress-UI) were reported by 44.9 % (n = 44), 36.7 % (n = 36) and 26.5 % (n = 26), respectively. Nocturia was noted in 68 % (n = 67). Overall, 15.3 % (6 men and 9 women) reported diuretic avoidance. Avoidance of diuretics was 27.3 % (n = 12), 25.5 % (n = 9) and 34.6 % (n = 9) among participants with urgency-UI, stress-UI and mixed-UI, respectively, while only 6.8 % (n = 3) of participants without any UI reported diuretic avoidance. After adjusting for age, sex and diuretic type (loop vs. others), both urgency-UI (odds ratio 5.9 95 % CI 1.5-22.8) and mixed-UI (odds ratio 5.7; 95 % CI 1.6-19.9) were significantly associated with diuretic avoidance compared to participants without urgency-UI, or mixed-UI, respectively. Stress-UI and nocturia were not significantly associated with diuretic avoidance. CONCLUSIONS: UI is common among older adults with CKD receiving diuretics. Patients with urgency-UI are more likely to avoid diuretics.
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