Is furosemide (frusemide) effective in treating or preventing acute renal failure in adults?

In-hospital mortality is not affected by the use of high-dose furosemide to treat or prevent acute renal failure, and furosemide increases the hospital length of stay. (LOE = 1a)

Ho KM, Sheridan DJ. Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ 2006;333:406-407.  [PMID:16861256]

Meta-analysis (randomized controlled trials)

Self-funded or unfunded

Inpatient (ICU only)

The rationale behind loop diuretic use in acute renal failure is the better prognosis of nonoliguric renal failure as compared with oliguric renal failure; artificially maintaining urine production with a diuretic seems, therefore, to make sense. These researchers combined the results of 9 randomized controlled trials enrolling a total of 849 patients. The studies were found through a search of 3 databases and checking the reference lists of retrieved articles. Two researchers independently selected the studies and abstracted the data. The quality of the study was low (Jadad score = 2.6 of 5). Doses of furosemide varied among the studies and included continuous infusion or single bolus doses. Doses ranged from 600 to 3400 mg daily for treatment. In-hospital mortality was approximately 32% and was not different between groups treated with furosemide or placebo to prevent or treat acute renal failure. Furosemide use to prevent acute renal failure increased the length of hospital stay by an average 3.57 days (95% CI, 0.03 - 7.12; P = .049). The need for dialysis was heterogeneous across studies but was not affected by the use of furosemide. The authors report a possibility of publication bias in which small studies showing a benefit of furosemide have not been published.