Diuretics and mortality in acute renal failure.
OBJECTIVE
According to recent research, diuretics may increase mortality in acute renal failure patients. The administration of diuretics in such patients has been discouraged. Our objective was to determine the impact of diuretics on the mortality rate of critically ill patients with acute renal failure.


METHODS
Prospective, multiple-center, multinational epidemiologic study.


METHODS
Intensive care units from 54 centers and 23 countries.


METHODS
Patients were 1,743 consecutive patients who either were treated with renal replacement therapy or fulfilled predefined criteria for acute renal failure.


METHODS
Three distinct multivariate models were developed to assess the relationship between diuretic use and subsequent mortality: a) a propensity score adjusted multivariate model containing terms previously identified to be important predictors of outcome; b) a new propensity score adjusted multivariate model; and c) a multivariate model developed using standard methods, compensating for collinearity.


RESULTS
Approximately 70% of patients were treated with diuretics at study inclusion. Mean age was 68 and mean Simplified Acute Physiology Score II was 47. Severe sepsis/septic shock (43.8%), major surgery (39.1), low cardiac output (29.7), and hypovolemia (28.2%) were the most common conditions associated with the development of acute renal failure. Furosemide was the most common diuretic used (98.3%). Combination therapy was used in 98 patients only. In all three models, diuretic use was not associated with a significantly increased risk of mortality.


CONCLUSIONS
Diuretics are commonly prescribed in critically ill patients with acute renal failure, and their use is not associated with higher mortality. There is full equipoise for a randomized controlled trial of diuretics in critically ill patients with renal dysfunction.
Department of Intensive Care, Austin and Repatriation Medical Centre, Melbourne, Australia.
Shigehiko
S
Uchino
Gordon S
GS
Doig
Renaldo
R
Bellomo
Hiroshi
H
Morimatsu
Stanislao
S
Morgera
Miet
M
Schetz
Ian
I
Tan
Catherine
C
Bouman
Ettiene
E
Nacedo
Noel
N
Gibney
Ashita
A
Tolwani
Claudio
C
Ronco
John A
JA
Kellum
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000401:mortality*; D000368:Aged; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D014943:Global Health; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies
D004232:Diuretics