A systematic review including 9 studies with a total of 849 subjects was abstracted in DARE. Furosemide at doses of 1 or 2.5 mg/hour (intravenous infusion) or 80 mg (single intravenous bolus) in the prevention trials and 600 to 3400 mg/day in the treatment trials was compared to placebo. Outcome measures not significantly different after furosemide treatment were in-hospital mortality (RR 1.11, 95% CI 0.92 to 1.33), risk for requiring renal replacement therapy or dialysis (RR 0.99, 95% CI 0.80 to 1.22), number of dialysis sessions required (weight mean difference, WMD -0.48 sessions, 95% CI -1.45 to 0.50), and proportion of patients with persistent oliguria (urine output < 500 ml/day: RR 0.54, 95% CI 0.18 to 1.61). Stratifying studies that used furosemide to prevent or treat acute renal failure did not change the results on mortality and the risk for requiring dialysis. High-dose furosemide (1 to 3.4 g/day) was associated with a suggestion of an increased risk of temporary deafness and tinnitus (RR 3.97, 95% CI 1.00 to 15.78).
In a pilot multi-center randomized blinded placebo-controlled trial adult patients with AKI were randomly allocated to furosemide bolus and infusion (n=37) or 0.9% saline placebo (n=36). Primary endpoint was worsening AKI, defined by the RIFLE criteria. 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 renal replacement therapy (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.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment in some studies) and by imprecise results (limited study size for each comparison).