Abstract
Objective: Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on the epidemiology and progression of CKD in low-middle-income countries. Chronic use of diuretics is considered to further decrease renal clearance, a pathophysiology not very clearly understood. Free light chains renal deposition is precipitated by loop diuretics. This study attempted to determine whether chronic diuretic usage was associated with increase serum free light chain and a reduction in renal clearance among CKD patients. Design and method: A single-center, record-based study of 84 CKD patients with an established diagnosis of CKD, loop diuretic therapy, between June 2019 and December 2019 was conducted after ethical approval by institutional ethics committee ((RIMS/2018/32). The study included participants with age above 18 years of age, never dialysed, non-neoplastic (specifically plasma cell disorder), non-pregnant, and those on loop diuretic were divided into 3 groups: group 1 with Furosemide exposure more than 6 months; Group 2 with furosemide exposure between 3 months to 6 months but less than 6 months; and Group 3 with furosemide exposure less than 3 months. Results: 46 out of 84 patients were of group 1, 20 belonged to group 2 and 18 were in group 3. In group 1, mean eGFR of 103.6, mean free kappa of 100.98 and mean lambda of 126.65.2 was observed. Group 2 patients had mean eGFR of 125.6 with mean free kappa of 80.98 and mean lambda of 1002.2, whereas group 3 had mean eGFR of 15 5.5, mean free kappa of 79.8 and mean lambda of 96.65.2. It was also observed that 98% patients with stage 5 CKD had high serum free lambda level. Conclusions: This study revealed a strong association of serum free light chain level with stage of CKD in patients on diuretic therapy. Therefore, monitoring of Serum Free Light Chain among CKD patients on diuretic therapy can be an indirect evidence of furosemide induced renal function worsening.
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