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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Acute Kidney Injury | Research

Impact of furosemide on mortality and the requirement for renal replacement therapy in acute kidney injury: a systematic review and meta-analysis of randomised trials

Authors: Łukasz J. Krzych, Piotr F. Czempik

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

Objective

To examine the impact of furosemide on mortality and the need for renal replacement therapy (RRT) in adult patients with acute kidney injury (AKI) based on current evidence.

Data sources

PubMed (Medline) and Embase were searched from 1998 to October 2018.

Study selection

We retrieved data from randomised controlled trials comparing prevention/treatment with furosemide at any stage of AKI with alternative treatment/standard of care/placebo. The outcome was short-term mortality and the requirement for RRT, when applicable.

Data extraction

Two reviewers independently extracted appropriate data. PRISMA guidelines were followed for data preparation and reporting.

Data synthesis

We identified 20 relevant studies (2608 patients: 1330 in the treatment arm and 1278 in the control arm). Heterogeneity between studies was deemed acceptable, and the publication bias was low. Furosemide had neither an impact on mortality (OR = 1.015; 95% CI 0.825–1.339) nor the need for RRT (OR = 0.947; 95% CI 0.521–1.721). Furosemide had also no effect on the outcomes in strata defined by intervention strategy (prevention/treatment), AKI origin (cardio-renal syndrome, post-cardiopulmonary bypass, critical illness), control arm comparator (RRT, saline/placebo/standard of care) and its dose (< 160/≥ 160 mg) (p > 0.05 for all). Subjects who received furosemide with matched hydration in prevention of contrast-induced nephropathy (CIN) had a less frequent need for RRT (OR = 0.218; 95% CI 0.05–1.04; p = 0.055).

Conclusions

Furosemide administration has neither an impact on mortality nor the requirement for RRT. Patients at risk of CIN may benefit from furosemide administration. Further well-designed RCTs are needed to verify these findings.
Appendix
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Literature
1.
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.CrossRef
2.
Uchino S, Bellomo R, Goldsmith D, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34:1913–7.PubMedCrossRef
3.
Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73.PubMedPubMedCentralCrossRef
4.
Hoste EA, Kellum JA. Acute renal failure in the critically ill: impact on morbidity and mortality. Contrib Nephrol. 2004;144:1–11.PubMedCrossRef
5.
Minuth AN, Terrell JB Jr, Suki WN. Acute renal failure: a study of the course and prognosis of 104 patients and of the role of furosemide. Am J Med Sci. 1976;271(3):317–24.PubMedCrossRef
6.
Mehta RL, Pascual MT, Soroko S, et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288(20):2547–53.PubMedCrossRef
7.
Lassnigg A, Donner E, Grubhofer G, et al. Lack of renoprotective effects of dopamine and furosemide during cardiac surgery. J Am Soc Nephrol. 2000;11(1):97–104.PubMed
8.
Cantarovich F, Rangoonwala B, Lorenz H, et al. High-dose furosemide for established ARF: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Am J Kidney Dis. 2004;44(3):402–9.PubMedCrossRef
9.
10.
Bagshaw SM, Delaney A, Haase M, et al. Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis. Crit Care Resusc. 2007;9:60–8.PubMed
11.
Karajala V, Mansour W, Kellum JA. Diuretics in acute kidney injury. Minerva Anestesiol. 2009;75(5):251–7.PubMed
12.
Landoni G, Bove T, Székely A, et al. Reducing mortality in acute kidney injury patients: systematic review and international web-based survey. J Cardiothorac Vasc Anesth. 2013;27(6):1384–98.PubMedCrossRef
13.
Bove T, Belletti A, Putzu A, et al. Intermittent furosemide administration in patients with or at risk for acute kidney injury: meta-analysis of randomized trials. PLoS One. 2018;13(4):1–18.CrossRef
14.
15.
16.
Badawy SI, Fahmy A. Efficacy and cardiovascular tolerability of continuous veno-venous hemodiafiltration in acute decompensated heart failure: a randomized comparative study. J Crit Care. 2012;27(1):7–13.CrossRef
17.
Bagshaw SM, Gibney RTN, Kruger P, et al. The effect of low-dose furosemide in critically ill patients with early acute kidney injury: a pilot randomized blinded controlled trial (the SPARK study). J Crit Care. 2017;42:138–46.PubMedCrossRef
18.
Barbanti M, Gulino S, Capranzano P, et al. Acute kidney injury with the RenalGuard System in patients undergoing transcatheter aortic valve replacement: the PROTECT-TAVI Trial (PROphylactic effecT of furosEmide-induCed diuresis with matched isotonic intravenous hydraTion in Transcatheter Aortic Valve Implantation). JACC Cardiovasc Interv. 2015;8(12):1595–604.PubMedCrossRef
19.
Bart BA, Boyle A, Bank AJ, et al. Ultrafiltration versus usual care for hospitalized patients with heart failure: the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure (RAPID-CHF) trial. J Am Coll Cardiol. 2005;46(11):2043–6.PubMedCrossRef
20.
21.
Berthelsen RE, Perner A, Jensen AK, et al. Forced fluid removal in intensive care patients with acute kidney injury: the randomised FFAKI feasibility trial. Acta Anaesthesiol Scand. 2018;62(7):936–44.PubMedCrossRef
22.
Briguori C, Visconti G, Focaccio A, et al. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): renalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation. 2011;124(11):1260–9.PubMedCrossRef
23.
Costanzo MR, Johannes RS, Pine M, et al. The safety of intravenous diuretics alone versus diuretics plus parenteral vasoactive therapies in hospitalized patients with acutely decompensated heart failure: a propensity score and instrumental variable analysis using the Acutely Decompensated Heart Failure National Registry (ADHERE) database. Am Heart J. 2007;154(2):267–77.PubMedCrossRef
24.
Costanzo MR, Saltzberg MT, Jessup M, et al. Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: results from UNLOAD. J Card Fail. 2010;16(4):277–84.PubMedCrossRef
25.
Costanzo MR, Negoianu D, Jaski BE, et al. Aquapheresis versus intravenous diuretics and hospitalizations for heart failure. JACC Heart Fail. 2016;4(2):95–105.PubMedCrossRef
26.
Dussol B, Morange S, Loundoun A, et al. A randomized trial of saline hydration to prevent contrast nephropathy in chronic renal failure patients. Nephrol Dial Transplant. 2006;21(8):2120–6.PubMedCrossRef
27.
28.
Hanna MA, Tang WH, Teo BW, et al. Extracorporeal ultrafiltration vs. conventional diuretic therapy in advanced decompensated heart failure. Congest Heart Fail. 2012;18(1):54–63.PubMedCrossRef
29.
Lim E, Ali ZA, Attaran R, et al. Evaluating routine diuretics after coronary surgery: a prospective randomized controlled trial. Ann Thorac Surg. 2002;73(1):153–5.PubMedCrossRef
30.
Mahesh B, Yim B, Robson D, et al. Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur J Cardiothorac Surg. 2008;33(3):370–6.PubMedCrossRef
31.
Marenzi G, Ferrari C, Marana I, et al. Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS (induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy prevention) trial. JACC Cardiovasc Interv. 2012;5(1):90–7.PubMedCrossRef
32.
Marenzi G, Muratori M, Cosentino ER, et al. Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail. 2014;20(5):1–9.
33.
van der Voort PH, Boerma EC, Koopmans M, et al. Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit Care Med. 2009;37(2):533–8.PubMedCrossRef
34.
Cheng Z, Wang L, Hu S. Efficacy and safety of ultrafiltration in decompensated heart failure patients with renal insufficiency. Int Heart J. 2015;56:319–23.PubMedCrossRef
35.
Putzu A, Boscolo Berto M, Belletti A, et al. Prevention of contrast-induced acute kidney injury by furosemide with matched hydration in patients undergoing interventional procedures: a systematic review and meta-analysis of randomized trials. JACC Cardiovasc Interv. 2017;10(4):355–63.PubMedCrossRef
36.
Krzych Ł, Czempik P. Loop diuretics and mortality in patients with acute kidney injury. In: Landoni G, Pisano A, Zangrillo A, Bellomo R, editors. Reducing mortality in acute kidney injury. Bern: Springer; 2016. p. 175–84.CrossRef
37.
Joannidis M, Druml W, Forni LG, et al. Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med. 2017;43(6):730–49.PubMedPubMedCentralCrossRef
38.
Malbrain ML, Marik PE, Witters I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014;46(5):361–80.PubMedCrossRef
39.
40.
Silbert BI, Ho KM, Lipman J, et al. Determinants of urinary output response to IV furosemide in acute kidney injury: a pharmacokinetic/pharmacodynamic study. Crit Care Med. 2016;44(10):923–9.CrossRef
41.
Malbrain ML, Van Regenmortel N, Owczuk R. The debate on fluid management and haemodynamic monitoring continues: between Scylla and Charybdis, or faith and evidence. Anaesthesiol Intensive Ther. 2014;46(5):313–8.PubMedCrossRef
42.
Hahn RG, He R, Li Y. Central venous pressure as an adjunct to flow-guided volume optimisation after induction of general anaesthesia. Anaesthesiol Intensive Ther. 2016;48(2):110–5.PubMedCrossRef
43.
van der Mullen J, Wise R, Vermeulen G, et al. Assessment of hypovolaemia in the critically ill. Anaesthesiol Intensive Ther. 2018;50(2):141–9.PubMedCrossRef
44.
Ricci F, Ramírez T, Marmorato R, et al. Predisposing factors for acute kidney injury in Hispanic patients treated with diuretics for decompensated heart failure. P R Health Sci J. 2013;32(2):63–7.PubMed
45.
46.
Silbert BI, Ho KM, Lipman J, et al. Does furosemide increase oxidative stress in acute kidney injury? Antioxid Redox Signal. 2017;26(5):221–6.PubMedCrossRef
47.
Shiao CC, Huang TM, Spapen HD, et al. Optimal timing of renal replacement therapy initiation in acute kidney injury: the elephant felt by the blindmen? Crit Care. 2017;21(1):146.PubMedPubMedCentralCrossRef
48.
Czempik P, Cieśla D, Knapik P, et al. Outcomes of patients with acute kidney injury with regard to time of initiation and modality of renal replacement therapy—first data from the Silesian Registry of Intensive Care Units. Kardiochir Torakochirurgia Pol. 2016;13(2):122–9.PubMedPubMedCentral
49.
Nash DM, Przech S, Wald R, et al. Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit. J Crit Care. 2017;41:138–44.PubMedCrossRef
Metadata
Title
Impact of furosemide on mortality and the requirement for renal replacement therapy in acute kidney injury: a systematic review and meta-analysis of randomised trials
Authors
Łukasz J. Krzych
Piotr F. Czempik
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0557-0

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