Are diuretics helpful in acute renal failure?

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Q&A

Are diuretics helpful in acute renal failure?

J Fam Pract. 2003 March;52(3):183-200

By

Lawrence Dybedock, MD

Kevin Kane, MD, MSPH

BACKGROUND: Diuretics continue to be widely used for treating acute renal failure despite the lack of supporting evidence. The ability to promote renal salt and water excretion with diuretics and extracellular volume overload in patients with acute renal failure influences the decision of many practitioners to use these medications.
POPULATION STUDIED: The authors studied 552 critically ill patients with acute renal failure in 4 California academic medical center ICUs. In patients without previous kidney disease, acute renal failure was defined as blood urea nitrogen >40 mg/dL or creatinine >2 mg/dL. In others, acute renal failure was defined as creatinine levels rising at >1 mg/dL compared with baseline. Patients were excluded if they had previous dialysis, urinary tract obstruction, or hypovolemia.
STUDY DESIGN AND VALIDITY: Patients in this prospective cohort study were placed into groups according to which day diuretics were initiated during the first week following consultation. Patients were also categorized as “ever” or “never” having received diuretics. Patients received 1 or more of the following: furosemide, bumetanide, metolazone, and hydrochlorothiazide.
OUTCOMES MEASURED: The primary outcomes were mortality, nonrecovery of renal function, and length of hospital stay.
RESULTS: Of the 552 patients included in the final sample, 294 (53%) died in the hospital. Of the 258 patients who survived, 17 required dialysis following discharge. Diuretics were used in 326 patients (59%).

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Are diuretics helpful in acute renal failure?

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