The Pharmaceutical Journal
Vol 269 No 7226 p771
30 November 2002

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Diuretics associated with an increased risk of death in acute renal failure

The use of diuretics in critically ill patients with acute renal failure is associated with an increased risk of death, a new study shows. Diuretics were also found to be associated with non-recovery of renal function in these patients.

Researchers analysed data collected over a six-year period for 552 patients with acute renal failure. They found that 59 per cent of patients were taking diuretics at the time of assessment and 12 per cent started taking diuretics after assessment.

A total of 294 (53 per cent) of the patients died in hospital, 56 of whom recovered renal function before death. Among those who survived, 17 were dialysis dependent after discharge. The increased risk of death or non-recovery of renal function was magnified (odds ratio 3.12, 95 per cent confidence interval, 1.14–2.76) when patients who died within the first week following assessment were excluded.

The researchers say that possible explanations for the association between diuretic use and both mortality in hospital and non-recovery of renal function include a direct toxic effect of diuretics or indirect effects either related or unrelated to renal function.

They say that although they cannot determine that diuretics are harmful, it is highly unlikely that diuretics afford patients with acute renal failure any material benefit. They conclude: "In the absence of compelling contradictory data from a randomised, blinded clinical trial, the widespread use of diuretics in critically ill patients with acute renal failure should be discouraged." (JAMA 2002;288:2547.)

Caroline Ashley, principal pharmacist, renal services, Royal Free Hospital, London, told The Journal that although it is difficult to say that the use of diuretics causes an increased risk of death and non-recoverable renal function, the study clearly raises concern about the prolonged use of diuretics in critically ill patients.

"We do know that in low doses, diuretics reduce tubular workload. It could be that in critically ill patients with poor renal function, large doses of diuretics are indeed harmful to kidneys. Alternatively, the diuretic therapy may have been continued for too long before dialysis was instigated," she said.