Furosemide infusion prevents the requirement of renal replacement therapy after cardiac surgery.
OBJECTIVE
Acute kidney injury (AKI) is a devastating complication following cardiac surgery and the ideal management is controversial. This prospective, randomized, open-label and double-blinded study analyzed the renoprotective effects of furosemide infusion and intermittent bolus therapy administered with dopamine infusion in cardiac surgical patients.


METHODS
Between August 1, 2007 and July 31, 2008, 100 adult patients undergoing elective coronary artery bypass surgery (CABG) surgery with normal renal function (creatinine <1.4 mg/dl) were enrolled in the study. The patients were randomized for the comparison of intermittent (Group 1, n=50, 1mg-3mg/kg) and continuous infusion of furosemide (Group 2, n=50, 10mg/ml). Continuous variables were expressed as mean+/- SD and compared by unpaired Student's t test or ANOVA for repeated measures. Statistical significance was assumed if p value was <0.05.


RESULTS
Renal replacement therapy (RRT) was used in 5% of patients (all in group 1, p=0.028). The 30-day mortality was 5%. Only 2 patients became hemodialysis dependent in group 1. Group 2 patients showed a continuous and higher urine output postoperatively than group 1 (p<0.001). Both groups had significant increase in peak postoperative serum creatinine values (p<0.001), however peak postoperative creatinine-clearance was significantly lower in group 1 (p<0.001).


CONCLUSIONS
Acute kidney injury necessitating RRT makes a small percentage of patients undergoing cardiac surgery and if RRT is not required the survival is excellent. Continuous infusion of furosemide seems to be effective in promoting diuresis and decreasing the need for RRT. However further multicenter studies with different doses of furosemide are required to confirm these results.
Kunt
Atike Tekeli
AT
Department of Cardiovascular Surgery, Bahçelievler Medicana Hospital, Istanbul, Turkey. atikemd@gmail.com
Akgün
Serdar
S
Atalan
Nazan
N
Bitir
Nazan
N
Arsan
Sinan
S
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D004231:Diuresis; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007262:Infusions, Intravenous; D007668:Kidney / Q000293:injuries; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D017582:Renal Replacement Therapy / Q000379:methods* / Q000401:mortality
D004232:Diuretics; D005665:Furosemide; D003404:Creatinine