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Are Diuretics Beneficial in Acute Renal Failure?

The odds of in-hospital mortality and nonrecovery of renal function were significantly higher among diuretic users than nonusers.

Physicians frequently administer diuretics to hospitalized patients in the early phase of acute renal failure (ARF), in attempts to minimize fluid overload and convert oliguric ARF to nonoliguric ARF. However, there is no evidence to support this practice. In this cohort study, researchers examined whether diuretic therapy influenced outcomes among 552 patients with ARF who underwent nephrology consultations in 4 intensive care units.

Diuretics were being used by 59% of patients at the time of renal consultation, and an additional 12% used diuretics during the following week. In a multivariable analysis adjusting for numerous potentially confounding variables, diuretic use was associated with significant increases in in-hospital mortality and nonrecovery of renal function (odds ratio for each outcome, about 1.7). In further analyses using propensity scores (another method to adjust for selection bias in nonrandomized studies), diuretics still were associated with worse outcomes. Patients who failed to respond to diuretics (i.e., those who did not exhibit increases in urine output) had higher risk for death or need for dialysis than did patients who responded to diuretics or who received no diuretics; this suggests that failure to respond to diuretics might be a predictor of poor outcome.

Comment: Although results from this observational study do not prove definitively that diuretics are harmful for critically ill patients with ARF, they cast strong doubt on the idea that diuretics are beneficial. Both the authors and editorialists discourage the use of diuretics in this setting.

— Allan S. Brett, MD

Published in Journal Watch General Medicine December 20, 2002

Citation(s):

Mehta RL et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002 Nov 27; 288:2547-53.

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Lameire N et al. Loop diuretics for patients with acute renal failure: Helpful or harmful? JAMA 2002 Nov 27; 288:2599-601.

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• Medline abstract (Free)