Acute renal failure:and oliguria: high dose frusemide had no clear effect on urine output or death.

Clinical bottom line (level 1b-)

  1. In patients with acute renal failure and oliguria, high dose frusemide had no clear effect on diuresis or mortality.
Cantarovich et al: Postgraduate Medical Journal 1971; 47 (Aprilsuppl): 13-17
Expires July 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: military hospital, Argentina

47 patients (aged ?, ?% male) acute renal failure and oliguria (<400 ml/day) despite mannitol 60 g iv within 24 hours of the start of the study
Control Group: (n = 13, 13 analysed): no diuretic
Experimental Group: (n = 34, 34 analysed): frusemide 600 mg iv daily or frusemide 100 mg increasing daily on a geometric basis to 3200 mg daily. (the exact schedule was not specified, though the very high doses were clearly often given over long infusion periods, eg. 10 hours. Neither regime seems to have involved a continuous infusion). The results from these two groups are combined in the tubular summaries.
Patients had dialysis if urea >53 mmol/L, K>6 mmol/L or creatinine >712 micromol/L.
100% followed for ?

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
urine output >400 mL/day unknown 7
(53.9%)		 22
(64.7%)		 18%
(-54% to 56%)		 9.73%
(-22.1% to 41.6%)		 10
(NNT = 2 to infinity;
NNH = 5 to infinity)
death unknown 7
(53.9%)		 15
(44.1%)		 -20%
(-110% to 31%)		 -10.9%
(-42.4% to 20.6%)		 -9
(NNT = 5 to infinity;
NNH = 2 to infinity)

  • Patients were followed until discharge.

    • Comments

    1. Causes of renal failure were obstetrical/gynaecologic (47%), surgery/trauma (17%) and miscellaneous (26%).
    2. The differences were more pronounced when presented for the very high and high dose groups separately, with the very high dose faring best. Lack of documentation of baseline differences and small numbers and the absence of statistical comparisons limits the inferences that should be made from this work.
    3. Ototoxicity was observed in the very high dose group but does not seem to have produced lasting sequelae.
    4. Moderate doses (240-500 mg of furosemide a day) along with thiazide diuretics (for its booster effect) are still used often to enhance diuresis in patients with oliguria. The practice, however, is not backed by substantial evidence.

    Citation

    1. Cantarovich F, Locatelli A, Fernandez JC, et al: Frusemide in high doses in the treatment of acute renal failure. Postgraduate Medical Journal 1971; 47 (Aprilsuppl): 13-17
    Search Terms: reference list review article
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, May 2000
    Reviewer: Mohammad Saklayen

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure furosemide
    Comparison no diuretic
    Outcome death and urine output