The use of loop diuretics in acute renal failure in critically ill patients – maintenance of renal function
Date First Published:
March 15, 2005
Last Updated:
March 15, 2005
Report by:
Anthony Davis, SpR Anaesthesia (Northwest School Anaesthesia)
Search checked by:
Ingrid Gooch, Northwest School Anaesthesia
Three-Part Question:
In [critically ill patients with acute renal failure] does [the use of loop diuretics] help maintain [renal function]?
Clinical Scenario:
A 70-year-old male is admitted to the intensive care unit with a severe biliary sepsis. He is develops multi-organ failure, is placed on a ventilator and receives inotropic and vasopressor support. He becomes anuric over the next two days, despite adequate fluid resuscitation. He is commenced on renal replacement therapy when he develops fluid overload. You wonder if you could have preserved his renal function and reduced his chances of requiring renal replacement therapy by the use of a loop diuretic.
Search Strategy:
OVID Medline 1966 to February Week 3 2005.
Search Details:
(exp Kidney Failure, Acute/ or acute renal failure.mp. or acute kidney failure.mp. or ARF.mp.) and (exp Diuretics/ or exp Diuretics, Sulfamyl/ or loop diuretic$.mp. or furosemide.mp. or frusemide.mp. or bumetanide.mp. or ethacrynic acid.mp.) limited to English, Humans, Adults, (Clinical Trial or Randomized Controlled Trial)
Outcome:
46 papers were found of which 4 directly answered the three part question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery. Sirivella S. Gielchinsky I. Parsonnet V. 2000 USA | 100 patients with acute renal failure after cardiac surgery. | Randomized controlled trial | Need for dialysis. | Loop diuretics decreased need for dialysis in combination with mannitol and dopamine, not alone. | No diuretic free control. Only cardiac surgery patients. |
| Loop diuretics in the management of acute renal failure: A prospective, double-blind, placebo-controlled, randomized study. Shilliday IR, Quinn KJ, Allison ME. 1997 UK | 92 patients with acute renal failure | Randomized controlled trial | Renal recovery, dialysis, death | Loop diuretics do not alter mortality, or the need for dialysis | All patients received dopamine and mannitol also. Not critically ill/ICU patients. |
| Effect of postoperative intravenous loop diuretic on renal function after major surgery. Hager B. Betschart M. Krapf R. 1996 Switzerland | 121 ICU patients post-thoraco-abdominal surgery or vascular surgery | Randomized controlled trial | Effect of low-dose furosemide on renal function | Furosemide did not prevent deterioration in renal function. | No patients with severe renal failure enrolled. No patient exclusion criteria. |
| Furosemide and dopamine in malarial acute renal failure. Lumlertgul, D. Keoplung, M. Sitprija, V. Moollaor, P. Suwangool, P. 1989 Thailand | 23 patients with falciparum malaria with acute renal failure | Randomized controlled trial | Effect of frusemide and dopamine on renal function | Frusemide did not alter the clinical course of renal failure. Frusemide and dopamine combination preserved renal failure if creatinine < 400mumol/l. | Small study. Only patients with malaria. No diuretic-free control used. |
Author Commentary:
There is no evidence that loop diuretics used alone help maintain renal function in critically ill patients with acute renal failure. There is some evidence that loop diuretics in combination with dopamine (Lumlertgul 1989) or dopamine and mannitol (Sirivella 2000) may preserve renal function in certain patient sub-groups.
Bottom Line:
No evidence to suggest that in critically ill patients with acute renal failure the use of loop diuretics help maintain renal function.
References:
- Sirivella S. Gielchinsky I. Parsonnet V.. Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery.
- Shilliday IR, Quinn KJ, Allison ME.. Loop diuretics in the management of acute renal failure: A prospective, double-blind, placebo-controlled, randomized study.
- Hager B. Betschart M. Krapf R.. Effect of postoperative intravenous loop diuretic on renal function after major surgery.
- Lumlertgul, D. Keoplung, M. Sitprija, V. Moollaor, P. Suwangool, P.. Furosemide and dopamine in malarial acute renal failure.