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Update in Nephrology
- Stanley Goldfarb, MD*
- From the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
2007 Series: Update Sessions from Internal Medicine 2007
The current Update in Nephrology reviews the most important recent articles relevant to those practicing nephrology. The Table summarizes changes to clinical practice that should emerge from these articles.
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Acute Renal Failure
Question: Is furosemide safe and effective for treating acute renal failure?
Study Design: Meta-analysis of randomized, controlled trials.
Data Sources: Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE.
Outcomes: Primary outcomes were in-hospital death and the proportion of patients requiring renal dialysis or replacement therapy. Secondary outcomes were the proportion of patients remaining oliguric (urine output <500 mL/d), proportion of patients who developed ototoxicity, number of dialysis sessions required until recovery, and length of hospital stay.
Results: 9 randomized, controlled trials met study criteria, comprising 849 patients with or at risk for acute renal failure. Furosemide did not affect in-hospital death (relative risk, 1.11 [CI, 0.92 to 1.33]), the requirement for renal replacement therapy (relative risk, 0.99 [CI, 0.80 to 1.22]), the number of dialysis sessions required (weighted mean difference, −0.48 session [CI, −0.45 to 0.50 session]), or the proportion of patients with persistent oliguria (0.54 [CI, 0.18 to 1.61]). The primary findings were unchanged when the analyses were stratified by preventive versus short-term treatment. Patients treated with high doses of furosemide might have been at increased risk for temporary deafness and tinnitus (relative risk, 3.97 [CI, 1.00 to 15.78]).
Conclusion: Furosemide was not associated with clinical benefit in the prevention and treatment of acute renal failure in adults, and high doses may be associated with an increased risk for ototoxicity.
Commentary: Some clinicians use loop diuretics to convert oliguric acute renal failure to nonoliguric failure, thereby improving fluid and electrolyte balance and possibly preventing the need for renal replacement therapy. In theory, loop diuretics might also serve as an anti-ischemic agent …
