Furosemide-Associated Acute Kidney Injury in Hospitalized Patients: A Risk and Prediction Tool

Abstract

Purpose Furosemide is the most widely used diuretic for congestive heart failure and edema; however, the risk of furosemide-associated acute kidney injury (FM-AKI) is unknown. Methods A total of 430,000 inpatients were enrolled in this study. Propensity score matching (PSM) was used to balance covariates across study groups, and then a nomogram was developed to predict FM-AKI. Results The incidence of AKI was 23.94% in the furosemide group and 16.72% in control group after PSM, and the risk of AKI increased with the dose of furosemide. According to the regression analysis, the single day total dose of furosemide was the most important factor for AKI, followed by administration in the intensive care unit (ICU), the estimated glomerular filtration rate, and 13 other indicators. The effect of furosemide in distinct clinical setting is different, subgroup analyses showed that furosemide acted synergistically with surgery and previous treatment with beta-blockers, ACEIs/ARBs and antibiotics to increase the risk of AKI. Then, we developed a prognostic visualized nomogram to predict AKI for furosemide users and found that patients with high scores might have a high risk of AKI; this finding was validated by calibration analyses. The agreement between the nomogram predictions and actual possibility of AKI was excellent, with a probability of 77.40%. Conclusion The use of furosemide in clinical practice requires scrutiny, and the dose, use of other medications and renal function of patients must be taken into account. Our practical prognostic FM-AKI model can help physicians with clinical decision-making and provide treatment guidance. Funding: This work was supported by the National Natural Science Foundation of China (81170688, 81470973, and 81770679). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Declaration of Interest: The authors have declared that no competing interests exist. Ethical Approval: Clinical data were obtained via electronic medical records and a database review and were deidentified to protect patient privacy. The Institutional Review Board approved this study. The need for informed consent was waived for this study.