Why Clinical Trails are not consistent with Clinical Experience: Observation of the Clinical Effect of High-dose Furosemide on Acute Kidney Injury
潘景业1 黄跃跃1 陈洁1 马继红1 王丹1
ICU，The First Affiliated Hospital，Wenzhou Medical College. Wenzhou 325000，Zhejiang，China；
Abstract Objective To investigate the role of high-dose furosemide used in patients with acute kidney injury (AKI). Methods 56 adult patients with AKI were retrospectively analysed. They were divided into high-dose furosemide group（observe group）and routine-dose furosemide group（control group）according to the treatment protocols，divided into non-oliguric AKI group and oliguric AKI group according to the daily urine volum during the first 24-hour treatment，and divided into hree phases according to the RIFLE criteria——Phase R (risk)，Phase I(injury) and Phase F (failure). The acute physiology and chronic health evaluation (APACHE)Ⅱscore, the 28-day mortality and the mortality in different phases of AKI were compared among each group. Results In the observe group, both the patients whose urine volume achieved >0.5ml/kg /h and >1.0ml/kg/h and the daily urine volume per hour during the first 3-day treatment, were significantly more than those in the control group (P<0.01). The proportion of non-oliguric AKI in the observe group was significantly larger than that in the control group after the first 3-day treatment; on the contrary, the proportion of hemodialysis needed and the time required for hemodialysis in the observe group were lower than those in the control group(P＜0.01).But the differences between the two groups in the 28-day mortality and the time needed for renal function recovery were not statistically significant (P＞0.05). The APACHE Ⅱ score and the 28-day mortality in the oliguric AKI group were both higher(P<0.01). The 28-day mortality in Phase F was higher than in the other two phases，with statistical significance (p<0.01). Conclusion On the basis of sufficient effective circulating blood volume, the early use of high-dose furosemide could significantly maintain or increase urine volume，promote oliguric AKI to non-oliguric AKI, and reduce the requirement and time needed for hemodialysis as well. Whereas, it did not affect the survival or renal recovery .
