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Evidence summaries

Furosemide to Prevent or Treat Acute Renal Failure in Adults

Furosemide may not be effective in the prevention or treatment of acute renal kidney injury in adults. Level of evidence: "C"

A Cochrane review

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.

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).

    References

    • Hashimoto H, Yamada H, Murata M, et al. Diuretics for preventing and treating acute kidney injury. Cochrane Database Syst Rev 2025;1(1):CD014937.[PubMed]
    • Zhao GJ, Xu C, Ying JC et al. Association between furosemide administration and outcomes in critically ill patients with acute kidney injury. Crit Care 2020;24(1):75. [PubMed]

Primary/Secondary Keywords