High-dose furosemide for established ARF: A prospective, randomized, double-blind, placebo-controlled, multicenter trial

Background: The effect of furosemide on the survival and renal recovery of patients presenting with acute renal failure (ARF) is still debated. Methods: Three hundred thirty-eight patients with ARF requiring dialysis therapy were randomly assigned to the administration of either furosemide (25 mg/kg/d intravenously or 35 mg/kg/d orally) or matched placebo, with stratification according to severity at presentation. The primary end point was survival. The secondary end point was number of dialysis sessions. Tertiary end points included time on dialysis therapy, time to achieve a serum creatinine level less than 2.26 mg/dL (<200 mu mol/L), and time to reach a 2-L/d diuresis. Results: There were no differences in survival and renal recovery rates between the 2 groups. Time to achieve a 2-L/d diuresis was shorter with furosemide (5.7 +/- 5.8 days) than placebo (7.8 +/- 6.8 days; P=0.004). Overall, 148 patients achieved a urine output of at least 2 L/d during the study period (94 of 166 patients; 57%) with furosemide versus 54 of 164 patients (33%) with placebo (P<0.001). However, there were no significant differences in number of dialysis sessions and time on dialysis therapy between the furosemide and placebo groups, even in the subgroup of patients reaching a 2-L/d diuresis. Conclusion: High-dose furosemide helps maintain urinary output, but does not have an impact on the survival and renal recovery rate of patients with established ARF.