BMJ  2006;333:420 (26 August), doi:10.1136/bmj.38902.605347.7C (published 21 July 2006)

Research

Meta-analysis of frusemide to prevent or treat acute renal failure

¹ Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia 6000

Abstract

Objective To investigate the potential beneficial and adverse effects of frusemide to prevent or treat acute renal failure in adults.

Design Meta-analysis of randomised controlled trials.

Data sources Cochrane controlled trials register (2005 issue 4), Embase, and Medline (1966 to 1 February 2006), without language restrictions.

Review methods Two reviewers checked the quality of the studies and independently extracted data.

Results Nine randomised controlled trials totalling 849 patients with or at risk of acute renal failure were included. Outcome measures not significantly different after frusemide treatment were in-hospital mortality (relative risk 1.11, 95% confidence interval 0.92 to 1.33), risk for requiring renal replacement therapy or dialysis (0.99, 0.80 to 1.22), number of dialysis sessions required (weight mean difference - 0.48 sessions, - 1.45 to 0.50), and proportion of patients with persistent oliguria (urine output < 500 ml/day: 0.54, 0.18 to 1.61). Stratifying studies that used frusemide to prevent or treat acute renal failure did not change the results on mortality (relative risk ratio 2.10, 95% confidence interval 0.67 to 6.63) and the risk for requiring dialysis (4.12, 0.46 to 37.2). Evidence suggested an increased risk of temporary deafness and tinnitus in patients treated with high doses of frusemide (relative risk 3.97, 95% confidence interval 1.00 to 15.78).

Conclusions Frusemide is not associated with any significant clinical benefits in the prevention and treatment of acute renal failure in adults. High doses may be associated with an increased risk of ototoxicity.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Acute renal failure

Rachel Hilton
BMJ 2006 333: 786-790. [Extract] [Full Text] [PDF]

Furosemide is not effective in preventing and treating acute renal failure
BMJ 2006 333: 0. [Full Text]

Early intervention in acute renal failure

David N Bennett-Jones
BMJ 2006 333: 406-407. [Extract] [Full Text] [PDF]

Measuring inconsistency in meta-analyses

Julian P T Higgins, Simon G Thompson, Jonathan J Deeks, and Douglas G Altman
BMJ 2003 327: 557-560. [Extract] [Full Text] [PDF]

Statistics Notes: Interaction revisited: the difference between two estimates

Douglas G Altman and J Martin Bland
BMJ 2003 326: 219. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Himmelfarb, J., Joannidis, M., Molitoris, B., Schietz, M., Okusa, M. D., Warnock, D., Laghi, F., Goldstein, S. L., Prielipp, R., Parikh, C. R., Pannu, N., Lobo, S. M., Shah, S., D'Intini, V., Kellum, J. A. (2008). Evaluation and Initial Management of Acute Kidney Injury. CJASN 3: 962-967 [Abstract] [Full text]  
• Moghal, N E, Shenoy, M (2008). Furosemide and acute kidney injury in neonates. Arch. Dis. Child. Fetal Neonatal Ed. 93: F313-F316 [Abstract] [Full text]  
• Mahesh, B., Yim, B., Robson, D., Pillai, R., Ratnatunga, C., Pigott, D. (2008). Does furosemide prevent renal dysfunction in high-risk cardiac surgical patients? Results of a double-blinded prospective randomised trial. Eur. J. Cardiothorac. Surg. 33: 370-376 [Abstract] [Full text]  
• Goldfarb, S. (2008). Update in Nephrology. ANN INTERN MED 148: 49-54 [Full text]  
• Abuelo, J. G. (2007). Normotensive Ischemic Acute Renal Failure. NEJM 357: 797-805 [Full text]  
• Bagshaw, S. M., Uchino, S., Bellomo, R., Morimatsu, H., Morgera, S., Schetz, M., Tan, I., Bouman, C., Macedo, E., Gibney, N., Tolwani, A., Oudemans-van Straaten, H. M., Ronco, C., Kellum, J. A., for the Beginning and Ending Supportive Therapy fo, (2007). Septic Acute Kidney Injury in Critically Ill Patients: Clinical Characteristics and Outcomes. CJASN 2: 431-439 [Abstract] [Full text]  
• Hilton, R. (2006). Acute renal failure.. BMJ 333: 786-790 [Full text]  
• (2006). Furosemide Doesn't Help Prevent or Treat Renal Failure. JWatch General 2006: 7-7 [Full text]  
• Bennett-Jones, D. N (2006). Early intervention in acute renal failure.. BMJ 333: 406-407 [Full text]  

Rapid Responses:

Read all Rapid Responses

Prolonged Frusemide Use and Strong Ion Difference

Awori J Hayanga
bmj.com, 28 Jul 2006 [Full text]

Strong ion difference in relation to frusemide use

Kwok M HO
bmj.com, 29 Jul 2006 [Full text]

Equipose on whether frusemide can improve outcome in acute renal failure

Sean M Bagshaw, et al.
bmj.com, 2 Aug 2006 [Full text]

Use of frusemide in acute renal failure

Kwok M Ho
bmj.com, 3 Aug 2006 [Full text]

Frusemide in Acute Renal Failure

Saul Blecker, et al.
bmj.com, 15 Sep 2006 [Full text]

Frusemide to prevent or treat acute renal failure

Marlies Ostermann, et al.
bmj.com, 9 Oct 2006 [Full text]