Nephrology Dialysis Transplantation, Vol 12, Issue 12 2592-2596, Copyright © 1997 by Oxford University Press
I Shilliday, K Quinn and M Allison
Background: Studies on the role of loop diuretics in
patients with acute renal failure (ARF) are largely retrospective,
anecdotal, and poorly controlled. We report the results of a prospective,
randomized, placebo-controlled, double-blind study examining the effect of
loop diuretics on renal recovery, dialysis, and death in patients with ARF.
Methods: Ninety-two patients with ARF were enrolled
into the study. All received intravenous dopamine, 2 &mgr;g/kg body
weight/min throughout, 20% mannitol, 100 ml every 6 h for the first 3 days,
and, in a double-blind manner, either torasemide, frusemide, or placebo, 3
mg/kg body weight i.v. every 6 h for 21 days or until renal recovery or
death. Results: Renal recovery, the need for dialysis,
and death were not different in the three groups. Patients given a loop
diuretic had a significant rise in urine flow rate in the first 24 h
compared to placebo (P=0.02). Based on the urine flow rate during the first
post-medication day patients were divided into two groups-oliguric
(<50 ml/h) and non-oliguric (⩾50 ml/h). Non-oliguric
patients had a significantly lower mortality than oliguric patients (43%
vs 69%, P=0.01). However they were less ill (APACHE II
score 17.2 vs 20.6, P=0.008) and had less severe renal
failure at entry (creatinine clearance 14 ml/min vs 4
ml/min, P<0.0001). Conclusion: The use of loop
diuretics in oliguric patients with ARF can result in a diuresis. There is
no evidence that these drugs can alter outcome. Key
words: acute renal failure; dopamine; loop diuretics; mannitol;
oliguria; placebo-controlled trial; randomized
ORIGINAL ARTICLES
Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study
The Renal Unit, Glasgow Royal Infirmary, UK; Boehringer Mannheim (UK) Pharmaceuticals; The Department of Medicine, The University of Glasgow, UK; Corresponding author at: Renal Unit, Stobhill Hospital, Balornock Road, Glasgow G21 3UW, UK
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