Diuretics in acute kidney injury.
BACKGROUND
In an acute care setting, diuretics are often prescribed to maintain or increase urine output in patients presenting with acute kidney injury (AKI). The rationale behind giving diuretics is that they may protect the kidney from ischemic injury by maintaining a nonoliguric state. There have been many studies both supporting and criticizing diuretic use in AKI for improving overall patient outcomes.


METHODS
A systematic review of the literature was conducted to evaluate the role of diuretics including osmotics, loop diuretics, and nesiritide in modifying AKI.


RESULTS
There was no evidence to suggest that the use of loop diuretics in AKI reduces mortality, the need for dialysis, the number of dialysis sessions, or length of Intensive Care Unit/hospital stay or that it increases the recovery of renal function. There is no benefit for the use of mannitol as an osmotic diuretic over hydration in rhabdomyolysis. In contrast, mannitol was found to cause more harm and to induce nephropathy. Nesiritide did not improve renal function in patients with decompensated heart failure and mild chronic renal insufficiency. Nesiritide may be effective in the prevention of AKI when applied in lower doses for a prolonged period of time in patients with mild to moderate renal insufficiency.


CONCLUSIONS
Diuretics have been shown to be ineffective in the prevention of AKI or for improving outcomes once AKI occurs. At best, diuretics can help decrease symptoms of pulmonary edema secondary to volume overload.
Karajala
V
V
Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
Mansour
W
W
Kellum
J A
JA
D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D000818:Animals; D015331:Cohort Studies; D003131:Combined Modality Therapy; D000075202:Contraindications; D003422:Critical Care / Q000706:statistics & numerical data; D004195:Disease Models, Animal; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D005440:Fluid Therapy; D005665:Furosemide / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008353:Mannitol / Q000009:adverse effects / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000209:etiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D012206:Rhabdomyolysis / Q000150:complications; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
D004232:Diuretics; D004234:Diuretics, Osmotic; D049994:Sodium Potassium Chloride Symporter Inhibitors; D020097:Natriuretic Peptide, Brain; D008353:Mannitol; D005665:Furosemide; D004298:Dopamine