Effects of post‐operative furosemide in adult surgical patients: A systematic review and meta‐analysis of randomised clinical trials

Winther‐Olesen, Marie; Møller, Morten Hylander; Johansen, K; Aasvang, Eske Kvanner

doi:10.1111/aas.13513

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…These outcomes are comparable with the available data. In the most recent meta-analysis, Winther et al 18 AKI is a complex pathophysiology process influenced by multiple factors. Common preoperative risk factors include female sex, 37 advanced age, 38 obesity, and multiple comorbidities (hypertension, diabetes mellitus, hypercholesterolemia, pre-existing chronic kidney disease, previous CS, chronic obstructive pulmonary disease, congestive heart failure, and a left ventricular ejection fraction of <35%).…”

Section: Discussionmentioning

confidence: 99%

“…These outcomes are comparable with the available data. In the most recent meta‐analysis, Winther et al 18 observed no statistically significant difference between furosemide and no furosemide‐treated adult surgical patients in any of the predefined outcome measures, including AKI incidence (relative risk[RR]: 1.07, 95% CI: 0.43–2.65), all‐cause mortality (RR: 1.73, 95% CI: 0.62–4.80), need for RRT rate (RR: 3.87, 95% CI: 0.44–33.99). However, this meta‐analysis only included four trials, and the surgical methods vary greatly, three trials were CS (most recent trial was published in the year of 2017), and another trial were abdominal/chest/vascular surgery.…”

Section: Discussionmentioning

confidence: 99%

“…16 The incidence of AKI after CABG was related to the use of preoperative furosemide, which increased exponentially with the increase of cumulative dose of furosemide. 17 The meta-analysis by Winther et al 18 found that furosemide treated had no statistically significant difference on the incidence of AKI, need for renal replacement therapy (RRT) rate, and all-cause mortality in adult surgical patients.…”

Section: Introductionmentioning

confidence: 99%

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Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA‐compliant systematic review and meta‐analysis

Xie

Yao

Yang

et al. 2022

Journal of Cardiac Surgery

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Objective Acute kidney injury (AKI) is a common complication of cardiac surgical patients, the occurrence of which is multifactorial. Furosemide is the most common loop diuretic and widely used in cardiac surgery to reduce fluid overload, increase tubular flow and urine output. It remains unknown whether furosemide affects the incidence or prognosis of cardiac surgery‐induced acute kidney injury (CS‐AKI). Therefore, the current study was performed to address this question. Methods PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases were searched for relevant studies. Primary outcomes of interest included postoperative CS‐AKI incidence, need for renal replacement therapy (RRT) rate. Secondary outcomes of interest included postoperative serum creatinine (Scr) and blood urea nitrogen (BUN) levels, postoperative mechanical ventilation duration (MVD), length of stay (LOS) in intensive care unit (ICU) and in hospital, and mortality. The odds ratio (OR) and/or the weighted mean difference (WMD) with 95% confidence interval (CI) were used to pool the data. Results Database search yielded six studies including 566 adult patients, and 283 patients were allocated into Group Furosemide and 283 into Group Control (Placebo). Heterogeneity between studies was deemed acceptable, and the publication bias was low. Meta‐analysis suggested that furosemide administration in adult cardiac surgical patients had no effect on CS‐AKI incidence (n = 4 trials; OR = 0.92; 95% CI: 0.37–2.30; p = .86; I2 = 57%) and need for RRT rate (n = 2 trials; OR = 4.13; 95% CI: 0.44–38.51; p = .21; I2 = 0%). Diversely, furosemide administration in adult cardiac surgical patients significantly decreased postoperative BUN level (n = 3 trials; WMD = 0.71; 95% CI: 0.10–1.33; p = .02; I2 = 0%), postoperative MVD (n = 2 trials; WMD = −3.13; 95% CI: −3.78 to −2.49; p < .00001; I2 = 0%) and postoperative LOS in ICU (n = 3 trials; WMD = −0.47; 95% CI: −0.76 to −0.18; p = .001; I2 = 0%). However, it had no significant impact on postoperative Scr level, postoperative LOS in hospital, and postoperative mortality. Conclusion This meta‐analysis suggested that furosemide administration in adult cardiac surgical patients had no significant effect on CS‐AKI incidence, need for RRT rate, postoperative Scr level, LOS in hospital and mortality, but could reduce postoperative BUN level, MVD, and LOS in ICU. As only a limited number of studies were included, these results should be interpreted carefully and cautiously. Future high‐quality randomized controlled trials are needed to define the role of furosemide in CS‐AKI prevention and management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA‐compliant systematic review and meta‐analysis

Xie

Yao

Yang

et al. 2022

Journal of Cardiac Surgery

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“…Indeed, a recent systematic review and meta-analysis comparing the role of furosemide in prevention and treatment at any stage of AKI concluded that furosemide had neither and impact on mortality nor requirement of renal replacement therapy (12). Moreover, a recent systematic review and metaanalysis in adult surgical patients has shown the use of furosemide in AKI was associated to very low to no firm evidence for benefit or harm (13).…”

Section: Discussionmentioning

confidence: 99%

Risk of acute kidney injury by initiation of non-steroidal anti-inflammatory drugs in hospitalised patients treated with diuretics and renin–angiotensin–aldosterone system inhibitors

et al. 2021

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ObjectivesConcurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) with diuretics and reninangiotensin-aldosterone system inhibitors (RAASI) has been associated to an increased risk of developing acute kidney injury (AKI) in ambulatory setting. There is currently no information on AKI prevalence in hospitalized patients where initiation of NSAID prescription is quite frequent. The aim of our study was to assess the prevalence of AKI in patients treated with diuretics and/or RAASI in the hospital setting when NSAIDs are initiated. MethodsRetrospective single center study on inpatients receiving triple or dual association. AKI was established according to evidence-based clinical practice guidelines in kidney disease (Kidney Disease Improving Global Outcome, KDIGO criteria) using the following criteria : increase in SCr by ≥ 0.3mg/dL (or ≥26.5 µmol/L) within 48 hours or increase in SCr to ≥ 1.5 times baseline occurring within the last 7 days. ResultsAKI was identified in 5 of 151 patients (3.3%) treated with both diuretics and RAASI in whom NSAIDs were initiated with a 49 µM average increase in SCr within 48h compared to baseline. AKI was identified in 2 of 117 (1.7%) patients treated with diuretics and NSAIDs, and in 1 of 427 (0.23%) patients treated with RAASI and NSAIDs. The average increase in SCr within 2 days was 29µM. No Aki was identified in a control group of 1,886 patients treated by diuretics and RAASI with no NSAIDs initiation during their hospitalization. ConclusionInitiation of NSAID therapy in hospitalized patients already treated with diuretics and RAASI is a risk factor for AKI. The risk of AKI with the triple association appeared higher than with the dual association.

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“… 66 Another systematic review and meta-analysis in 2020 showed no benefit with the use of frusemide in reducing the postoperative AKI. 67 …”

Section: G Uidelines —A Cute K ...mentioning

confidence: 99%

ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy

Chaudhry¹,

Chacko²,

Govil³

et al. 2022

Indian Journal of Critical Care Medicine

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Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. How to cite this article Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al . ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13–S42.

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Effects of post‐operative furosemide in adult surgical patients: A systematic review and meta‐analysis of randomised clinical trials

Cited by 7 publications

References 22 publications

Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA‐compliant systematic review and meta‐analysis

Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA‐compliant systematic review and meta‐analysis

Risk of acute kidney injury by initiation of non-steroidal anti-inflammatory drugs in hospitalised patients treated with diuretics and renin–angiotensin–aldosterone system inhibitors

ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy

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