Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study

Background: Studies on the role of loop diuretics inpatients with acute renal failure (ARF) are largely retrospective,anecdotal, and poorly controlled. We report the results of a prospective,randomized, placebo-controlled, double-blind study examining the effect ofloop diuretics on renal recovery, dialysis, and death in patients with ARF.Methods: Ninety-two patients with ARF were enrolledinto the study. All received intravenous dopamine, 2 &mgr;g/kg bodyweight/min throughout, 20% mannitol, 100 ml every 6 h for the first 3 days,and, in a double-blind manner, either torasemide, frusemide, or placebo, 3mg/kg body weight i.v. every 6 h for 21 days or until renal recovery ordeath. Results: Renal recovery, the need for dialysis,and death were not different in the three groups. Patients given a loopdiuretic had a significant rise in urine flow rate in the first 24 hcompared to placebo (P=0.02). Based on the urine flow rate during the firstpost-medication day patients were divided into two groups-oliguric(<50 ml/h) and non-oliguric (⩾50 ml/h). Non-oliguricpatients had a significantly lower mortality than oliguric patients (43%vs 69%, P=0.01). However they were less ill (APACHE IIscore 17.2 vs 20.6, P=0.008) and had less severe renalfailure at entry (creatinine clearance 14 ml/min vs 4ml/min, P<0.0001). Conclusion: The use of loopdiuretics in oliguric patients with ARF can result in a diuresis. There isno evidence that these drugs can alter outcome. Keywords: acute renal failure; dopamine; loop diuretics; mannitol;oliguria; placebo-controlled trial; randomized