Furosemide by continuous infusion to reduce mortality in patients with acute kidney injury

Abstract

Acute kidney injury and fluid overload are common in critically ill patients and both associated with increased mortality. Furosemide has several pharmacological properties that could theoretically protect the kidneys against ischaemic injury by decreasing oxygen consumption. Furosemide might also counteract the harmful effects of fluid overload by promoting diuresis and achieving negative fluid balance. Few randomised trials have compared furosemide administration as either bolus doses or continuous infusion, and in most of them surrogate outcomes have been used. No differences in mortality were observed in two studies, whereas another study found a lower mortality with continuous infusion. A meta-analysis focusing on continuous infusion versus bolus administration of furosemide found no difference in mortality between the two regimens. In conclusion, there is only weak evidence to support that furosemide by continuous infusion may provide advantages as compared with bolus doses.