The comparison of the diuretic and natriuretic efficacy of continuous and bolus intravenous furosemide in patients with chronic kidney disease.
OBJECTIVE
To compare natriuretic, kaliuretic, diuretic and free water clearance efficacy of continuous versus bolus intravenous furosemide administration in patients with chronic renal insufficiency.


METHODS
In a prospective randomized cross-over trial, 42 patients of chronic renal insufficiency were randomized to receive the same dose of intravenous furosemide as bolus and continuous infusion. The effects of bolus and intravenous administration of furosemide on the volume of urine, sodium and potassium excretion were assessed.


RESULTS
Mean age was 53.6 +/- 14 years and 23 (55%) were male. The mean modification of diet in renal disease glomerular filtration rate was 20.5 +/- 17 mL/min per 1.73 m(2). The urinary excretion of sodium in intravenous bolus and infusion was 98.1 +/- 78 and 114.4 +/- 100 mmol, respectively (P = 0.001). Total urinary volume following bolus and infusion of furosemide was 1064 +/- 627 and 1170 +/- 764 mL, respectively (0.001). The excretion of potassium was similar in bolus (15.8 +/- 16.6) and infusion (14.3 +/- 9) administration (P = 0.11). The fractional excretion of sodium was higher following infusion (16.63 +/- 16.1) than bolus administration (12.87 +/- 9) of furosemide (P = 0.016).


CONCLUSIONS
Continuous intravenous infusion of furosemide has significantly better natriuretic and diuretic effect than bolus administration of the same dose of the drug in patients with advanced chronic renal insufficiency.
Sanjay
Srinivas
S
Department of Nephrology, Apollo Hospitals, Chennai, India.
Annigeri
Rajeev A
RA
Seshadri
Rajagopalan
R
Rao
Budithi Subba
BS
Prakash
Kowdle C
KC
Mani
Muthu Krishna
MK
D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004231:Diuresis / Q000187:drug effects*; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects*; D045283:Natriuretic Agents / Q000008:administration & dosage*; D011188:Potassium / Q000652:urine; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D012964:Sodium / Q000652:urine; D016896:Treatment Outcome
D004232:Diuretics; D045283:Natriuretic Agents; D005665:Furosemide; D012964:Sodium; D011188:Potassium