Abstract
BackgroundAlthough current guidelines for AKI suggested against the use of furosemide in AKI management, the effect of furosemide on outcomes in real-world clinical settings remains uncertain. The aim of the present study was to investigate the association between furosemide administration and outcomes in critically ill patients with AKI using real-world data.MethodsCritically ill patients with AKI were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) matched analysis was used to match patients receiving furosemide to those without diuretics treatment. Linear regression, logistic regression model, and Cox proportional hazards model were used to assess the associations between furosemide and length of stay, recovery of renal function, and in-hospital and 90-day mortality, respectively.ResultsA total of 14,154 AKI patients were included in the data analysis. After PS matching, 4427 pairs of patients were matched between the patients who received furosemide and those without diuretics treatment. Furosemide was associated with reduced in-hospital mortality [hazard ratio (HR) 0.67; 95% CI 0.61–0.74; P < 0.001] and 90-day mortality [HR 0.69; 95% CI 0.64–0.75; P < 0.001], and it was also associated with the recovery of renal function [HR 1.44; 95% CI 1.31–1.57; P < 0.001] in over-all AKI patients. Nevertheless, results illustrated that 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 (A-on-C) renal injury.ConclusionsFurosemide administration was associated with improved short-term survival and recovery of renal function in critically ill patients with AKI. Furosemide was especially effective in patients with AKI UO stage 2–3 degree. However, it was not effective in those with AKI SCr stage 2–3 and chronic kidney disease. The results need to be verified in randomized controlled trials.
Highlights
Current guidelines for Acute kidney injury (AKI) suggested against the use of furosemide in AKI management, the effect of furosemide on outcomes in real-world clinical settings remains uncertain
Using the logistic regression model, the impact of furosemide use on the recovery of renal function was estimated, and we found that furosemide use was associated with an increased chance of renal function recovery (HR 1.29; 95% Confidence interval (CI) 1.21–1.38; P < 0.001)
Our results demonstrated furosemide administration was associated with reduced short-term mortality in critically ill patients with AKI
Summary
Current guidelines for AKI suggested against the use of furosemide in AKI management, the effect of furosemide on outcomes in real-world clinical settings remains uncertain. The aim of the present study was to investigate the association between furosemide administration and outcomes in critically ill patients with AKI using real-world data. Acute kidney injury (AKI) is common in critically ill patients and carries a high morbidity and mortality rate. Furosemide is the most common loop diuretic used in critically ill patients, and numerous clinical trials have been designed to evaluate the effectiveness of it in AKI. Several studies have suggested that furosemide might reduce the need for renal replacement therapy (RRT) and attenuate the severity of AKI [5, 6]. The effect of furosemide on outcomes of critically ill patients with AKI is still controversial and needs to be further investigated in large-scale studies. We hypothesized that furosemide administration was associated with decreased mortality in critically ill patients with AKI
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