High Dose Frusemide in Established Acute Renal Failure

Cantarovich, F; Galli, Claudia Inés; Benedetti, Luana; Chena, C.; Castro, L.; Correa, C.; Loredo, Jaime Pérez; Fernández, José Carlos Fernández; Locatelli, Alessandra; Tizado, J.

doi:10.1136/bmj.4.5890.449

Cited by 110 publications

(40 citation statements)

References 3 publications

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“…Therefore, oliguria is an important predictive characteristic of acute renal failure, and worse prognosis in oliguric ARF cases has been demonstrated in many series. 22,23,[34][35][36][37][38] The mortality observed among our patients was high (62.5%) and in accordance with other studies, in which mortality ranged from 50 to 90% among critically ill patients with ARF. 1,8 Liaño et al, 22 in a prospective study, found higher mortality among patients with ARF in the ICU (69.9%), in comparison with patients from clinical (42.8%), surgical (36.3%) and nephrology wards (18.1%).…”

Section: Discussionsupporting

confidence: 89%

“…Many studies have not shown any signifi cant benefi t from the use of diuretics for ARF cases. [31][32][33][34][35][36][37][38][39][40] In a recent study by Mehta et al, 41 it was demonstrated that the use of loop diuretics was associated with a 77% increase in the risk of death and non-recovery of renal function. The severity of ARF might be underestimated when the urine output is sustained, which may lead to a delay in instituting dialytic treatment.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for death among critically ill patients with acute renal failure

et al. 2006

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CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Risk factors for death among critically ill patients with acute renal failure

et al. 2006

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“…However, clinical studies gave contradictory results [17,18] and recently a metaanalysis showed that the overall preventive effect of theophylline against CN was modest and probably clinically non-significant [19]. Furosemide has the potential to protect the kidneys in the face of renal insults but clinical studies in different models of acute renal failure including CN did not demonstrate a protective effect [20][21][22][23]. But the use of furosemide in the setting of CN prevention by volume expansion can reduce the risk of fluid overload.…”

Section: Introductionmentioning

confidence: 99%

A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients

Dussol¹,

Morange²,

Loundoun³

et al. 2006

Nephrology Dialysis Transplantation

135

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Background. Contrast nephropathy (CN) is a common cause of renal dysfunction that may be prevented by saline hydration and by drugs such as theophylline or furosemide. Whether oral saline hydration is as efficient as intravenous saline hydration is unknown. The preventive efficacy of theophylline and furosemide for CN remains controversial. The purpose of the current study was to evaluate the efficacy of oral saline hydration and of intravenous saline hydration plus theophylline or furosemide for the prevention of CN. Methods. We prospectively studied 312 patients with chronic renal failure (serum creatinine 201±81 mmol/l, Cockcroft clearance 37±12 ml/min/1.73 m 2 ), who were undergoing various radiological procedures with a non-ionic, low osmolality contrast agent. Patients were randomly assigned to four arms. In arm A, patients received 1 g/10 kg of body weight/day of sodium chloride per os for 2 days before the procedure. In arm B, patients received 0.9% saline intravenously at a rate of 15 ml/kg for 6 h before the procedure. In arm C, patients received the same saline hydration as in arm B plus 5 mg/kg theophylline per os in one dose 1 h before the procedure. In arm D, patients received the same saline hydration as in arm B plus 3 mg/kg of furosemide intravenously just after the procedure. Results. Patients were well-matched with no significant differences at baseline in any measured parameters. Acute renal failure, defined as an increase in serum creatinine of 44 mmol/l (0.5 mg/dl), occurred in 27 out of 312 patients (8.7%). There was no significant difference between the rate of renal failure in the different arms of the study: five out of 76 (6.6%) in arm A, four out of 77 (5.2%) in arm B, six out of 80 (7.5%) in arm C and 12 out of 79 (15.2%) in arm D. No patient had fluid overload or a significant increase in blood pressure in the 2 days following the radiological procedure. The independent predictors of CN were diabetes mellitus, high baseline serum creatinine and high systolic blood pressure. Conclusions. Oral saline hydration was as efficient as intravenous saline hydration for the prevention of CN in patients with stage 3 renal diseases. Furosemide and theophylline were not protective.

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“…In patients with established ARF, several studies have found no benefit of loop diuretics (27)(28)(29)(30)(31)(32)(33) (Table 1). More particularly, loop diuretics did not accelerate renal recovery, reduce the need for dialysis, or decrease mortality.…”

Section: Diureticsmentioning

confidence: 99%