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J Crit Care. 2017 Dec;42:138-146. doi: 10.1016/j.jcrc.2017.07.030. Epub 2017 Jul 12.

The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study).

Author information

1
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Science Building, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada. Electronic address: bagshaw@ualberta.ca.
2
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Science Building, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada. Electronic address: ngibney@ualberta.ca.
3
Department of Intensive Care Medicine, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, and School of Medicine, University of Queensland, Queensland 4012, Australia. Electronic address: Peter.Kruger@health.qld.gov.au.
4
Epidemiology Coordinating and Research Centre (EPICORE), Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 362 Heritage Medical Research Centre, Edmonton, Alberta T6G 2S2, Canada. Electronic address: ihassan@ualberta.ca.
5
Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-112 Clinical Sciences Building, 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada. Electronic address: fmcalist@ualberta.ca.
6
Department of Intensive Care, Austin Hospital, Studley Rd, Heidelberg, Victoria 3084, Australia. Electronic address: rinaldo.bellomo@austin.org.au.

Abstract

PURPOSE:

Furosemide is commonly prescribed in acute kidney injury (AKI). Prior studies have found conflicting findings on whether furosemide modifies the course and outcome of AKI.

METHODS:

Pilot multi-center randomized blinded placebo-controlled trial in adult patients with AKI admitted to three intensive care units. Participants were randomly allocated to furosemide bolus and infusion or 0.9% saline placebo. Primary endpoint was worsening AKI, defined by the RIFLE criteria. Secondary endpoints were kidney recovery, renal replacement therapy (RRT) and adverse events.

RESULTS:

The trial was terminated after enrollment of 73 participants (37 to furosemide and 36 to placebo). Mean (SD) age was 61.7 (14.3), 79.5% were medical admissions, mean (SD) APACHE II score was 26.6 (7.8), 90.4% received mechanical ventilation and 61.6% received vasoactives. Groups were similar at baseline. No differences were found in the proportion with worsening AKI (43.2% vs. 37.1%, p=0.6), kidney recovery (29.7% vs. 42.9%, p=0.3), or RRT (27.0% s. 28.6%, p=0.8). Adverse events, mostly electrolyte abnormalities, were more common in furosemide-treated patients (p<0.001). Protocol deviations were common, due often to supplementary furosemide.

CONCLUSIONS:

In this pilot trial, furosemide did not reduce the rate of worsening AKI, improve recovery or reduce RRT; however, was associated with greater electrolyte abnormalities.

TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT00978354 registered September 9, 2014.

KEYWORDS:

Acute kidney injury; Furosemide; Mortality; Placebo; Randomized; Recovery; Renal replacement therapy; Urine output

PMID:
28732314
DOI:
10.1016/j.jcrc.2017.07.030
[Indexed for MEDLINE]

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