In a pilot multi-center randomized blinded placebo-controlled trial adult patients with AKI were randomly allocated to furosemide bolus and infusion (n=37) or 0.9% saline placebo (n=36). Primary endpoint was worsening AKI, defined by the RIFLE criteria. Groups were similar at baseline. No differences were found in the proportion with worsening AKI (43.2% vs. 37.1%, p=0.6), kidney recovery (29.7% vs. 42.9%, p=0.3), or renal replacement therapy (27.0% s. 28.6%, p=0.8). Adverse events, mostly electrolyte abnormalities, were more common in furosemide-treated patients (p<0.001). Protocol deviations were common, due often to supplementary furosemide.
A database analysis 3 matched critically ill patients receiving furosemide to those without diuretics treatment (4427 pairs) in real world settings. Furosemide was associated with reduced in-hospital mortality (hazard ratio 0.67; 95% CI 0.61 to 0.74; P < 0.001) and 90-day mortality (HR 0.69; 95% CI 0.64 to 0.75; P < 0.001), and it was also associated with the recovery of renal function (HR 1.44; 95% CI 1.31 to 1.57; P < 0.001) in over-all AKI patients. Nevertheless, furosemide was not associated with reduced in-hospital mortality in patients with AKI stage 0-1 defined by UO criteria, AKI stage 2-3 according to SCr criteria, and in those with acute-on-chronic renal injury.
A double-blind, placebo-controlled, randomized pilot trial 4 assessed furosemide infusion in early-onset AKI in critically ill children compared to placebo (n=75). The trial was stopped for futility. No significant difference was noted in the progression of AKI to a higher stage between furosemide and placebo groups (10.5% vs. 21.6%; RR 0.49, 95% CI 0.16 to 1.48). There were no differences in 28-day mortality or in the secondary outcomes. No trial-related severe adverse events occurred.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment in some studies) and by imprecise results (limited study size for each comparison).
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