Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial.
OBJECTIVE
To study the potential beneficial role of furosemide in resolving renal failure after hemofiltration in mechanically ventilated critically ill patients.


METHODS
Single-center randomized, double blind, placebo-controlled study.


METHODS
A 13-bed mixed intensive care unit (ICU) in a teaching hospital.


METHODS
Patients who had been treated with continuous venovenous hemofiltration were included.


METHODS
After the end of continuous venovenous hemofiltration, the urine of the first 4 hours was collected for measuring creatinine clearance. Patients were subsequently randomized for furosemide (0.5 mg/kg/hr) or placebo by continuous infusion. To prevent hypovolemia, the rate of fluid infusion was adapted every hour and was set as the urinary production of the previous hour.


RESULTS
End points were renal recovery (creatinine clearance more than 30 mL/min or stable serum creatinine without renal replacement therapy) in the ICU and in the hospital. Seventy-two patients were included and 71 were eligible for the analysis. The 36 furosemide-treated patients had a significantly increased urinary volume compared with the 35 placebo-treated patients (median 247 mL/hr (interquartile range [IQR] 774 mL/hr) vs. 117 mL/hr (IQR 158 mL/hr), p = 0.003) and greater sodium excretion (median 73 mmol/L (IQR 48) vs. 37 (IQR 48) mmol/L, p = 0.001). In the furosemide group 25 patients and in the placebo group 27 patients showed recovery of renal function at ICU discharge (p = 0.46). Two patients of the furosemide group needed long-term dialysis dependency (p = 0.23).


CONCLUSIONS
Furosemide by continuous infusion in the recovery phase of hemofiltration-dependent acute kidney failure did increase urinary volume and sodium excretion but did not lead to a shorter duration of renal failure or more frequent renal recovery.
van der Voort
Peter H J
PH
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Boerma
E Christiaan
EC
Koopmans
Matty
M
Zandberg
Mariët
M
de Ruiter
Joke
J
Gerritsen
Rik T
RT
Egbers
Peter H M
PH
Kingma
W Peter
WP
Kuiper
Michaël A
MA
D058186:Acute Kidney Injury / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use*; D006440:Hemofiltration; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010919:Placebos; D012121:Respiration, Artificial; D012720:Severity of Illness Index
D004232:Diuretics; D010919:Placebos; D005665:Furosemide