Furosemide in the management of acute kidney injury in the pediatric intensive care unit—retrospective cohort study

Abstract

ObjectiveTo evaluate the effects of furosemide administration in critically ill children on the progression of acute kidney injury (AKI) and its outcomes compared to those not receiving furosemide.MethodA retrospective cohort study involving children aged 1 month (corrected) to 13 years admitted to the pediatric intensive care unit (PICU) and who were diagnosed with AKI within 24 h was screened for enrollment. Those who received furosemide are classified as the furosemide group, and others as no-furosemide group. The primary outcome was the proportion of patients with AKI (risk or injury stage) progressing to a higher stage. The secondary outcomes were kidney replacement therapy (KRT), fluid balance (%FO), urine output, multi-organ dysfunction, kidney recovery, length of mechanical ventilation, hospital stay including PICU, and all-cause mortality (PICU and hospital).ResultsThree hundred sixty-two patients’ data [furosemide group, n = 182; no-furosemide group, n = 180] were enrolled. The median (IQR) pediatric risk of mortality–III score was similar between groups [10, 4–16 vs. 10, 4–16; p = 0.244]. The primary outcome occurred in 51 (28%) in the furosemide and 36 (20%) in the no-furosemide group. The difference was not statistically significant [RR = 1.40, 95% CI 0.96 to 2.04, p = 0.074]. Higher mean (SD) urine output (ml/kg/hr) was noted in the furosemide group [2.3 (0.9) vs. 1.4 (0.6); p = < 0.001). Significantly higher mean (SD) organ dysfunction score [10 (4) vs. 8.3 (4.4); p < 0.001) and increased median (IQR) length of stay in mechanical ventilation [4, 3–6 vs. 3, 2–6 days; p < 0.001] and hospital [8, 5–11 vs. 6, 5–8 days; p < 0.001] and lower kidney recovery at discharge was noted in the furosemide group [n = 86, 47.3% vs. n = 104, 57.8%; RR = 0.80, 95% CI 0.64 to 0.99; p = 0.044]. No difference was noted in all-cause mortality, fluid balance, and KRT requirement.ConclusionFurosemide infusion in AKI management did not reduce the progression to a higher stage of AKI. Nevertheless, it was associated with higher morbidities.