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


CONCLUSIONS
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.
Shilliday
I R
IR
Renal Unit, Glasgow Royal Infirmary, Scotland, UK.
Quinn
K J
KJ
Allison
M E
ME
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D004231:Diuresis / Q000187:drug effects; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005665:Furosemide / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011446:Prospective Studies; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D000077786:Torsemide
D004232:Diuretics; D010919:Placebos; D013449:Sulfonamides; D005665:Furosemide; D003404:Creatinine; D000077786:Torsemide