title: A meta-analysis of continuous vs intermittent infusion of loop diuretics in hospitalized patients.
abstract: BACKGROUND
  Several studies have examined the potential benefits of continuous vs intermittent (bolus) intravenous loop diuretic administration in hospitalized patients with conflicting results. We conducted a meta-analysis to compare the efficacy of these 2 strategies in hospitalized adults and children with extracellular fluid volume expansion.
  
  
  METHODS
  We searched MEDLINE (through October 2012) and prior meta-analyses for randomized controlled trials comparing the efficacy of continuous vs intermittent infusion of loop diuretics. Random-effects model meta-analyses were performed to examine several outcomes, including net change in urine output and body weight.
  
  
  RESULTS
  We identified 7 crossover and 11 parallel-arm randomized controlled trials (936 patients) of adults and children. In the 15 studies of adults, continuous loop diuretic infusion resulted in a nonsignificant net increase in daily urine output of 334 mL (95% confidence interval [CI], -74 to 742; P = .11) relative to the bolus infusion. In the 8 studies that used a loading dose, continuous loop diuretic infusion resulted in a significant net increase in daily urine output of 294 mL (95% CI, 31-557; P = .03) relative to the intermittent infusion. There was also a significant net decrease in body weight of 0.78 kg (95% CI, -1.54 to -0.03; P = .04) in the continuous relative to the intermittent loop diuretic infusion. In the 3 studies of children, there was no demonstrable effect on daily urine output or body weight.
  
  
  CONCLUSIONS
  Continuous infusion of loop diuretics preceded by a loading dose results in greater diuresis in hospitalized adults with extracellular fluid volume expansion compared with intermittent dosing regimens. Further studies are required to examine whether these benefits translate into improved clinical outcomes.
authors.affiliation: Division of Nephrology, Department of Medicine, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA.
authors.forename: Fahad
authors.initials: F
authors.lastname: Alqahtani
authors.affiliation: Division of Nephrology, Department of Medicine, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Koulouridis
authors.affiliation: Division of Nephrology, Department of Medicine, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA; Division of Nephrology, Department of Medicine, Extracorporeal Multiorgan Support Dialysis Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Paweena
authors.initials: P
authors.lastname: Susantitaphong
authors.affiliation: Division of Nephrology, Department of Medicine, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA.
authors.forename: Khagendra
authors.initials: K
authors.lastname: Dahal
authors.affiliation: Division of Nephrology, Department of Medicine, Kidney and Dialysis Research Laboratory, St Elizabeth's Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA. Electronic address: bertrand.jaber@steward.org.
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004334:Drug Administration Schedule; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016482:Urinalysis; D015431:Weight Loss
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors; D005665:Furosemide
keywords: Continuous; Infusion; Intermittent; Loop diuretics; Meta-analysis; Urine output