Acute renal failure: oliguria: sustained high doses of furosemide was of uncertain benefit.

Clinical bottom line (level 1b-)

  1. Patients with acute renal failure and oliguria who were given high doses of furosemide, were not clearly less likely to fail to diurese nor did their mortality rates differ from those not given furosemide.
Kleinknecht et al: Nephron 1976; 17: 51-58
Expires August 2003

The study

Unblinded concealed randomised trial with intention-to-treat
Setting: two university hospitals, France

66 patients (aged ?, 53% female) 'established' acute renal failure and oliguria (defined as urine/plasma osmolality <1.1; urine/plasma urea <10; and/or urine sodium concentration >30 mmol/L)

Excluded if
  • pre-existing chronic renal failure
  • obstructive uropathy
  • glomerulonephritis or systemic disease affecting the kidney


    • Note:
  • Aetiologies of acute renal failure were surgery/trauma (48%), obstetrical (23%) and medical (28%).


    • Control Group: (n = 33, 33 analysed): no furosemide
    Experimental Group: (n = 33, 33 analysed): furosemide 3 mg/kg i.v. over a few minutes, followed by repeat doses every 4 hours according to scale: urine output 150 ml/h- no furosemide; urine output 100-150 ml/h- 1.5 mg/kg furosemide; urine output 20-100 ml/h- 3 mg/kg furosemide; urine output <20 ml/h- 6 mg/kg furosemide.
    Urinary losses of fluid and electrolytes were replaced with i.v. fluids.
    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no diuretic response unknown 27
    (81.8%)    		 23
    (69.7%)    		 15%
    (-12% to 35%)    		 12.1%
    (-8.35% to 32.6%)    		 8
    (NNT = 3 to infinity;
    NNH = 12 to infinity)
    death unknown 12
    (36.4%)    		 13
    (39.4%)    		 -8%
    (-101% to 42%)    		 -3.03%
    (-26.4% to 20.4%)    		 -33
    (NNT = 5 to infinity;
    NNH = 4 to infinity)

  • Patients were followed until discharge.

    • Comments

    1. This is the first and only randomized prospective study of the use of loop diuretics in oliguric ARF.
    2. The proportion for whom dialysis was provided in the two groups was not reported, nor the threshold at which dialysis commenced.
    3. Power to detect an effect on mortality in this study was low.
    4. The answer to whether loop diuretics change morbidity or mortality in ARF has yet to be adequately answered

    Citation

    1. Kleinknecht D, Geneval D, Gonzalez-Duque LA, et al: Furosemide in acute oliguric renal failure: a controlled trial. Nephron 1976; 17: 51-58
    Search Terms: acute renal failure [MeSH] and oliguri* [text word] OR oliguria [MeSH]
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
    Reviewer: Harold Szerlip

    Clinical Question.
    Patient acute renal failure and oliguria
    Intervention or Exposure furosemide
    Comparison no furosemide
    Outcome mortality