Prophylactic furosemide infusion decreasing early major postoperative renal dysfunction in on-pump adult cardiac surgery: a randomized clinical trial

Abstract

IntroductionAcute renal dysfunction is a common complication of cardiac surgery. Furosemide is used in prevention, or treatment, of acute renal dysfunction. This study was conducted to evaluate the protective effects of intra- and early postoperative furosemide infusion on preventing acute renal dysfunction in elective adult cardiac surgery.MethodsEighty-one patients, candidates of elective cardiac surgery, were enrolled in this study in either the furosemide (n=41) or placebo (n=40) group. Furosemide (2 mg/h) or 0.9% saline was administered and continued up to 12 hours postoperatively. We measured serum creatinine (Scr) at preoperative and on the second and fifth postoperative days. Then calculated estimated glomerular filtration rate (eGFR) at these times. An increase in Scr of >0.5 mg/dL and/or >25%–50%, compared to preoperative values, was considered as acute kidney injury (AKI). In contrast, an increase in Scr by >50% and/or the need for hemodialysis was regarded as acute renal failure (ARF). At the end we compared the AKI or ARF incidence between the two groups.ResultsOn the second and fifth postoperative days, Scr was lower, and the eGFR was higher in the furosemide group. AKI incidence was similar in the two groups (11 vs 12 cases; P-value 0.622); however, ARF rate was lower in furosemide group (1 vs 6 cases; P-value 0.044). During the study period, Scr was more stable in the furosemide group, however in the placebo group, Scr initially increased and then decreased to its preoperative value after a few days.ConclusionThis study showed that intra- and early postoperative furosemide infusion has a renal protective effect in adult cardiac surgery with cardiopulmonary bypass. Although this protective effect cannot be discovered in mild renal dysfunctions, it apparently reduces the rate of the more severe renal dysfunctions. A more multidisciplinary strategy may be needed in reducing the milder renal damage.

The correlation of post-operative acute kidney injury and perioperative anaemia in patients undergoing cardiac surgery with cardiopulmonary bypass

“…In the study conducted by Fakhari et al, it was found that the rate of AKI after cardiac surgery can be reduced by using furosemide during surgery and in early postoperative period (22). In our study, 36.21% of patients received diuretic therapy during the early postoperative period in the ICU, but it did not influence the rate of AKI.…”

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

“…Our findings of no beneficiary effect of furosemide on post‐operative development of AKI are perhaps not surprising given the effect is predominantly increased urine output but not clearance …”

“…We identified 2567 records, whereof 20 full‐text articles were assessed for eligibility (Figure ). A total of four trials comprising a total of 325 patients were included . (Table ).…”

“…All trials were single‐centre trials. Three trials evaluated the effect of continuous infusion of furosemide vs placebo and one trial compared continuous infusion of renal dose dopamine with continuous infusion of furosemide vs placebo…”

“…This systematic review with meta‐analysis and trial sequential analysis (TSA) was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group . This protocol, including a statistical analysis plan, is available in the International Prospective Register of Systematic Reviews (PROSPERO), NO.…”