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

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

• Authors: I R Shilliday, K J Quinn, M E Allison
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 12 Issue 12 Pg. 2592-6 (Dec 1997) ISSN: 0931-0509 [Print] England
• PMID: 9430857 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Diuretics
• Placebos
• Sulfonamides
• Furosemide
• Creatinine
• Torsemide

Topics

• Acute Kidney Injury (drug therapy, mortality, physiopathology)
• Adult
• Aged
• Creatinine (metabolism)
• Diuresis (drug effects)
• Diuretics (adverse effects, therapeutic use)
• Double-Blind Method
• Female
• Furosemide (adverse effects, therapeutic use)
• Humans
• Male
• Middle Aged
• Placebos
• Prospective Studies
• Sulfonamides (adverse effects, therapeutic use)
• Torsemide