Loop diuretics in the management of acute renal failure : a prospective, double-blind, placebo-controlled, randomized study

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 1997-12, Vol.12 (12), p.2592-2596
• Main Authors: SHILLIDAY, I. R, QUINN, K. J, ALLISON, M. E. M
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - drug therapy; Acute Kidney Injury - mortality; Acute Kidney Injury - physiopathology; Adult; Aged; Biological and medical sciences; Creatinine - metabolism; Diuresis - drug effects; Diuretics - adverse effects; Diuretics - therapeutic use; Double-Blind Method; Female; Furosemide - adverse effects; Furosemide - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pharmacology. Drug treatments; Placebos; Prospective Studies; Renal failure; Sulfonamides - adverse effects; Sulfonamides - therapeutic use; Torsemide; Urinary system
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/12.12.2592

Studies on the role of loop diuretics in patients with acute renal failure (ARF) are largely retrospective, anecdotal, and poorly controlled. We report the results of a prospective, randomized, placebo-controlled, double-blind study examining the effect of loop diuretics on renal recovery, dialysis, and death in patients with ARF. Ninety-two patients with ARF were enrolled into the study. All received intravenous dopamine, 2 micrograms/kg body weight/min throughout, 20% mannitol, 100 ml every 6 h for the first 3 days, and, in a double-blind manner, either torasemide, frusemide, or placebo, 3 mg/kg body weight i.v. every 6 h for 21 days or until renal recovery or death. Renal recovery, the need for dialysis, and death were no different in the three groups. Patients given a loop diuretic had a significant rise in urine flow rate in the first 24 h compared to placebo (P = 0.02). Based on the urine flow rate during the first post-medication day patients were divided into two groups--oliguric (< 50 ml/h) and non-oliguric (> or = 50 ml/h). Non-oliguric patients had a significantly lower mortality than oliguric patients (43% vs 69%, P = 0.01). However, they were less ill (APACHE II score 17.2 vs 20.6, P = 0.008) and had less severe renal failure at entry (creatinine clearance 14 ml/min vs 4 ml/min, P < 0.0001). The use of loop diuretics in oliguric patients with ARF can result in a diuresis. There is no evidence that these drugs can alter outcome.