934

Abstract

Introduction: Continuous infusions (CI) of loop diuretics provide constant delivery of drug to site of action in the kidney, resulting in a continuous natriuretic effect. Data supporting the efficacy/safety of CI of high dose bumetanide (CIHDB) are sparse. A detailed review of a single institution’s experience will help fill the gap in literature. Hypothesis: CIHDB are effective in inducing diuresis and achieving dry weight in critically ill cardiac and cardiothoracic (CT) surgery patients (pts) with significant volume overload without causing new-onset acute renal failure. Methods: A retrospective electronic/paper chart review of all pts treated with a CIHDB at a single institution was performed. Pts receiving an infusion of 1-2 mg/hr bumetanide with sufficient data were included. Pts were excluded if the infusion rate remained <1 mg/hr or if receiving concomitant renal replacement therapy (RRT) or aquaphoresis. Data collected included weights, dosing of intermittent loop diuretics and CIHDB, urine output (UOP), serum creatinine, need for RRT. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to stage severity of acute kidney injury (AKI). Results: Thirty-eight pts treated for a mean of 53 hours were included. All pts received at least one dose of IV loop diuretics in the 24 hours preceding CIHDB, while 74% received a bolus of bumetanide IV 2-4 mg within 2 hours preceding CIHDB. Prior to initiation of CIHDB, mean volume overload was +6.2 kg (-1.8 to 11.8 kg) above dry weight; mean UOP was 0.9 cc/kg/hr (0.2-3 cc/kg/hr). After the first 24 hours, UOP increased to 1.6 cc/kg/hr (p<0.001) and to 1.9 cc/kg/hr (p<0.001) after the second 24 hours. Mean weight loss following CIHDB was 5.2 kg. At baseline, 16 (42%) had stage 1-2 AKI. Following CIDHB, 6 (38%) of these pts progressed to stage 3 AKI, but were maintained on CIHDB for 3-48 hours prior to RRT. After CIHDB, an additional 12 pts had stage 1-2 AKI, 10 of which were new onset. Conclusions: CIHDB is effective at improving UOP and achieving significant weight loss in critically ill cardiac and CT surgery pts. Optimizing diuretic therapy may potentially delay/avoid RRT. Further randomized, controlled studies are needed to support these results.