Association between furosemide administration and outcomes in critically ill patients with acute kidney injury

Abstract

Background: Although current guidelines for AKI suggested against the use of furosemide in AKI management, the effect of furosemide on outcomes in real-world clinical settings remains uncertain. The aim of the present study was to investigate the association between furosemide administration and outcomes in critically ill patients with AKI using real-world data. Methods: Critically ill patients with AKI were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) matched analysis was used to match patients receiving furosemide to those without diuretics treatment. Linear regression, logistic regression model, and Cox proportional hazards model were used to assess the associations between furosemide and length of stay, recovery of renal function, and inhospital and 90-day mortality, respectively. Results: A total of 14,154 AKI patients were included in the data analysis. After PS matching, 4427 pairs of patients were matched between the patients who received furosemide and those without diuretics treatment. Furosemide was associated with reduced in-hospital mortality [hazard ratio (HR) 0.67; 95% CI 0.61-0.74; P < 0.001] and 90-day mortality [HR 0.69; 95% CI 0.64-0.75; P < 0.001], and it was also associated with the recovery of renal function [HR 1.44; 95% CI 1.31-1.57; P < 0.001] in overall AKI patients. Nevertheless, results illustrated that furosemide was not associated with reduced in-hospital mortality in patients with AKI stage 0-1 defined by UO criteria, AKI stage 2-3 according to SCr criteria, and in those with acute-on-chronic (A-on-C) renal injury. Conclusions: Furosemide administration was associated with improved short-term survival and recovery of renal function in critically ill patients with AKI. Furosemide was especially effective in patients with AKI UO stage 2-3 degree. However, it was not effective in those with AKI SCr stage 2-3 and chronic kidney disease. The results need to be verified in randomized controlled trials.

Do critically ill patients with AKI benefit from furosemide? Further real-word evidence from a large multi-center database

“…Up to now, the main viewpoint is that diuretics including furosemide do not improve survival of AKI patients. The protective effect by improved renal function observed in some studies [1,4] (include Zhao's and ours) may be covered by the adverse events, such as electrolyte abnormalities [5]. Our study supports no benefit for furosemide on in-hospital mortality of AKI patients, despite a significant p value in the post-PSM dataset under the method of Cox regression (Table 1).…”

“…We appreciate Dr. Wang and his colleagues for their comments on our recent article related to the association between furosemide use and outcomes in critically ill patients with AKI [1]. Using the eICU database, they found that furosemide use was associated with increased renal function recovery rate but not reduced in-hospital mortality.…”

“…First, the protective effect of diuretic on AKI is at least partly mediated by fluid balance [1,6]. So, the diversities of volume status among different AKI cohorts need to be considered when interpreting the conflicting results.…”

Association of Preadmission Metformin Exposure and Outcomes in Acute Kidney Injury Patients with Type 2 Diabetes in Intensive Care Unit: a Cohort Study

“…KDIGO criteria are as follows [11]: increase in serum creatinine (SCr) to ≥1.5 times baseline must have occurred within the prior 7 days; or ≥0.3 mg/dl increase in SCr occurred within 48 h; or urine volume < 0.5 ml/kg/h for 6 h or more. The minimum of the SCr values available within the 7 days before admission was used as the baseline SCr [12,13]. When the preadmission SCr was not available, the rst SCr measured at admission was used as the baseline SCr [12,14].…”

“…The minimum of the SCr values available within the 7 days before admission was used as the baseline SCr [12,13]. When the preadmission SCr was not available, the rst SCr measured at admission was used as the baseline SCr [12,14]. The diagnosis of type 2 diabetes was based on International Classi cation of Disease, Ninth Revision (ICD-9).…”