Effect of high-dose furosemide on the prognosis of critically ill patients

Kim, Chong Whan; Lee, Myoung Kyu; Kim, Sang-Ha; Yong, Suk Joong; Lee, Won Yeon

doi:10.1016/j.jcrc.2017.04.045

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Multiple studies have evaluated the effect of IV furosemide in ICU patients [9,[17][18][19]. However, to the best of our knowledge, this is the first study to evaluate the effect of IV furosemide in patients admitted to the Internal Medicine Department.…”

Section: Discussionmentioning

confidence: 99%

Administration of Intravenous Furosemide in Patients with Acute Infection: Patient Characteristics and Impact on In-Hospital Outcome

Levi

Bnaya

Wolak

et al. 2023

JCM

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Intravenous (IV) fluid is frequently used to treat patients who have been admitted with an acute infection; among these patients, some will experience pulmonary congestion and will need diuretic treatment. Consecutive admissions to the Internal Medicine Department of patients with an acute infection were included. Patients were divided based on IV furosemide treatment within 48 h after admission. A total of 3556 admissions were included: In 1096 (30.8%), furosemide was administered after ≥48 h, and in 2639 (74.2%), IV fluid was administered within <48 h. Mean age was 77.2 ± 15.8 years, and 1802 (50.7%) admissions were females. In a multivariable analysis, older age (OR 1.01 [95% CI, 1.00–1.01]), male gender (OR 0.74 [95% CI, 0.63–0.86]), any cardiovascular disease (OR 1.51 [95% CI, 1.23–1.85]), congestive heart failure (CHF) (OR 2.81 [95% CI, 2.33–3.39), hypertension (OR 1.42 [95% CI, 1.22–1.67]), respiratory infection (OR 1.38 [95% CI, 1.17–1.63]), and any IV fluid administration (OR 3.37 [95% CI, 2.80–4.06]) were independently associated with furosemide treatment >48 h after hospital admission. In-hospital mortality was higher in patients with furosemide treatment (15.9% vs. 6.8%, p < 0.001). Treatment with furosemide in patients admitted with an infection was found to be associated with prolonged hospital stay and increased in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Administration of Intravenous Furosemide in Patients with Acute Infection: Patient Characteristics and Impact on In-Hospital Outcome

Levi

Bnaya

Wolak

et al. 2023

JCM

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“…It is also employed to prevent or limit kidney injury by uncoupling sodium absorption, thus conserving energy and oxygenation [18]. To date, however, there has been little de nitive evidence that it is so [9,[19][20][21][22][23][24][25][26]. Additionally, diuretic use was independently associated with an increased risk of AKI among the hospitalized Covid-19 patients which is a disease characterised with widespread in ammation [11,27,28].…”

Section: Discussionmentioning

confidence: 99%

Furosemide exacerbated the impairment of renal function, oxygenation and medullary damage in a rat model of renal ischemia/reperfusion induced AKI.

Dilken

İnce

Kapucu

et al. 2022

Preprint

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Background: Perioperative Acute Kidney Injury (AKI) caused by Ischemia-Reperfusion (IR) is a significant contributor to mortality and morbidity after major surgery. Furosemide is commonly used in postoperative patients to promote diuresis and reduce tissue edema. However, its effects on renal microcirculation, oxygenation and function after AKI are poorly understood. Herein, we investigated the effects of furosemide in rats subjected to IR insult. Methods: 24 Wistar albino rats were divided into 4 groups, with 6 in each; Sham-operated Control (C), Control + Furosemide (C+F), ischemia/reperfusion (IR), and IR+F. After induction of anaesthesia (BL), supra-aortic occlusion was applied to IR and IR+F groups for 45 minutes followed by ongoing reperfusion for 15 minutes (T1) and 2 hours(T2). Furosemide infusion was initiated simultaneously in the intervention groups after ischemia. Renal blood flow (RBF), vascular resistance (RVR), oxygen delivery (DO2ren) and consumption (VO2ren), sodium reabsorption (TNa+), oxygen utilization efficiency (VO2/TNa+), cortical (CμO2) and medullar (MμO2) microvascular oxygen pressures, urine output (UO) and creatinine clearance (Ccr) were measured. Biomarkers of inflammation, oxidative and nitrosative stress were measured and kidneys were harvested for histological analysis. Results: IR significantly decreased RBF, mainly by increasing RVR, which was exacerbated in the IR+F group at T2 (2198 vs 4223 dyne/s/cm5, p<0.05). CμO2 (61.65±6.8 vs 86.02±6.67 mmHg) and MμO2 (51.18±4.16 vs 68.79±4.98 mmHg, p<0.05) were both reduced after IR and did not improve by Furosemide. Moreover, VO2/TNa+ deteriorated in the IR+F compared to IR (78,5±63% vs IR+F:422,5±707% compared to BL values, p=0,07) suggesting a possible harm. Ccr did not change and plasma creatinine increased significantly in IR+F. Histopathology revealed widespread damage both in the cortex and medulla in IR+F and C+F groups. Conclusion: Renal oxygen delivery, medullar and cortical oxygenation and oxygen utilization all declined by furosemide administration after IR insult. Our study suggests that furosemide may cause additional structural and functional impairment to the kidney following ischemic injury and should be used with caution.

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“…Previous studies that found an association between early diuretic use and mortality used different patient populations ( 7 ) or used different analytic methods without or with less complete adjustment for baseline characteristics ( 8 ). For example, in an analysis of the Program to Improve Care in Acute Renal Disease ( 7 ), diuretic use on the day of nephrology consultation was associated with a 1.68 (95% CI, 1.06–2.64) higher odds of in-hospital mortality; however, that study cohort was restricted to patients with AKI.…”

Section: Discussionmentioning

confidence: 99%

“…A recent analysis of early diuretic use in patients on vasopressors reported a greater than 25% decrease in the odds of mortality ( 6 ). Other observational studies have suggested an adverse effect of diuretics on mortality ( 7 , 8 ).…”

mentioning

confidence: 98%