Increased incidence of diuretic use in critically ill obese patients

J Crit Care. 2015 Jun;30(3):619-23. doi: 10.1016/j.jcrc.2015.01.023. Epub 2015 Feb 7.


Objective: Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated.

Methods: In a large single-center cohort of critically ill patients, we evaluated whether admission body mass index was associated with the administration of either oral or intravenous diuretics during the intensive care unit (ICU) stay.

Main results: Of 7724 critically ill patients, 3946 (51.1%) were prescribed diuretics during the ICU stay. Overweight, class I obesity, and class II/III obesity were associated with a 1.35 (95% confidence interval [CI], 1.20-1.53; P < .001), 1.56 (95% CI, 1.35-1.80; P < .001), and 1.91 (95% CI, 1.61-2.26; P < .001) adjusted risk of receiving diuretics within the ICU, respectively. In adjusted analysis, a 5-kg/m(2) increment of body mass index was associated with a 1.19 (95% CI, 1.14-1.23; P < .001) increased adjusted risk of within-ICU diuretics. Among those patients receiving loop diuretics, obese patients received significantly larger daily diuretic doses.

Conclusion: Critically ill obese patients are more likely to receive diuretics during their stay in the ICU and to receive higher dosages of diuretics. Our data suggest that obesity is an independent risk factor for sodium retention.

Keywords: BMI; Fluid balance; Loop diuretics; Sodium retention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Cohort Studies
  • Critical Illness / epidemiology*
  • Databases, Factual
  • Diuretics / administration & dosage
  • Diuretics / therapeutic use
  • Female
  • Humans
  • Incidence
  • Intensive Care Units
  • Logistic Models
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Overweight / epidemiology
  • Risk Factors
  • Sodium Potassium Chloride Symporter Inhibitors / administration & dosage
  • Sodium Potassium Chloride Symporter Inhibitors / therapeutic use*
  • Water-Electrolyte Balance
  • Water-Electrolyte Imbalance / drug therapy*
  • Water-Electrolyte Imbalance / epidemiology


  • Diuretics
  • Sodium Potassium Chloride Symporter Inhibitors