Is Loop Diuretic Use in End Stage Renal Disease Really Safe? No-Diuretics versus Diuretics for Euvolemia in Hemodialysis Trial

NO DUH Trial is a three arm, double blind, placebo control, multi-center trial. Incident dialysis patients with at least 360 mL of urine a day are randomized to:

1. Placebo
2. Diuretic 1: Furosemide at 80 mg twice a day but then titrated up to maximize urine output (up to 500 mg per day) without going below a doctor established “dry weight”. Investigators would be encouraged to keep these patients euvolemic based on clinical judgment.
3. Diuretic 2: Furosemide at 80 mg twice a day with no adjustment for urine output or renal function.

Patients would be randomized to the three arms at a 2:1:1 ratio so that half of the patients receive diuretics and then the two different diuretic strategies would be tested.

Outcomes:

• Time until first hospitalizations (could be surrogate for mortality)
• Number of hospitalizations and length of stay
• Quality of life
• Intradialytic weight gain
• Residual renal output
• Neurohormonal measures (Renin, Aldosterone, Endothelin-1, Catecholamines)
• Blood pressure (Number of medications, dosage)
• Echocardiogram (Baseline, 1 year)