Diuretics in the management of acute kidney injury: a multinational survey.
BACKGROUND
Diuretics are a common intervention in critically ill patients with acute kidney injury (AKI). However, there is no information that describes the practice patterns of diuretic use by clinicians.


METHODS
Multinational, multicenter survey of intensive care and nephrology clinicians that utilized an 18-question self-reported questionnaire.


RESULTS
The survey generated 331 responses from 16 countries. Academic institutions comprised 77.5%, with the remaining being from metropolitan, regional or private hospitals. The use of furosemide was most common (67.1%), delivered primarily intravenously (71.9%) and by bolus dosing (43.3%). Other diuretics were infrequently used. The majority rated current serum creatinine (73.6%) and urine output (73.4%), blood pressure (59.7%), central venous pressure (65.2%) and risk of toxicity (62.4%) important when deciding on a dose. Pulmonary edema was a prime physiologic indication for diuretic use (86.3%). Diuretic use was also common with rhabdomyolysis (55.6%), major surgery (56%), and cardiogenic shock (56.2%), and sepsis (49.5%). Diuretic use was most commonly given either prior to (57.7%) or during recovery (33.9%) after renal replacement therapy (RRT). Most (76.6%) targeted a diuresis of >or=0.5-1.0 ml/kg/h. The majority did not believe that diuretics could reduce mortality (74.3%), reduce need for (50.8%) or duration of RRT (57.8%) or improve renal recovery (68.2%), however, many stated uncertainty. Most (85.1%) would be willing to participate in a randomized trial (RCT) of diuretics in AKI with 72.4% believing it ethically acceptable to allocate patients to placebo.


CONCLUSIONS
Diuretics are frequently used in AKI. Clinicians are most familiar with furosemide given intravenously and titrated to a physiologic endpoint of urine output. Most clinicians believe an RCT on diuretic use in AKI is justified and ethical. This survey confirms clinical agreement and a need for higher quality evidence on diuretic use in AKI.
Bagshaw
Sean M
SM
Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alta., Canada. bagshaw.sean@gmail.com
Delaney
Anthony
A
Jones
Daryl
D
Ronco
Claudio
C
Bellomo
Rinaldo
R
D058186:Acute Kidney Injury / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006306:Health Surveys; D006801:Humans; D007275:Injections, Intravenous; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011654:Pulmonary Edema / Q000175:diagnosis; D017582:Renal Replacement Therapy
D004232:Diuretics; D005665:Furosemide; D003404:Creatinine