Preoperative use of furosemide may increase the incidence of acute kidney injury after coronary artery bypass grafting: a propensity score-matched study

Zheng, Hui; Le, Liu; Fan, Guoliang; Liu, Zhigang; Wang, Zhengqing; Chang, Baocheng

doi:10.1007/s11748-021-01599-0

Cited by 6 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other authors found no benefit of furosemide use in the perioperative period, including no difference in the need for renal replacement therapy after the surgery [123][124][125]. Zheng et al [126] found that preoperative use of furosemide was associated with higher CSA-AKI risk.…”

Section: Fluid Balance and Osmotic Regulationmentioning

confidence: 98%

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Udzik,

Pacholewicz,

Biskupski

et al. 2023

JCM

View full text Add to dashboard Cite

Introduction: According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20–50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. Conclusions: Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. Future directions: The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.

show abstract

Section: Fluid Balance and Osmotic Regulationmentioning

confidence: 98%

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Udzik,

Pacholewicz,

Biskupski

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Furthermore, a prospective cohort study reported that furosemide was even detrimental in the protection of renal dysfunction after CS 16 . The incidence of AKI after CABG was related to the use of preoperative furosemide, which increased exponentially with the increase of cumulative dose of furosemide 17 . The meta‐analysis by Winther et al 18 found that furosemide treated had no statistically significant difference on the incidence of AKI, need for renal replacement therapy (RRT) rate, and all‐cause mortality in adult surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA‐compliant systematic review and meta‐analysis

Xie

Yao

Yang

et al. 2022

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Objective Acute kidney injury (AKI) is a common complication of cardiac surgical patients, the occurrence of which is multifactorial. Furosemide is the most common loop diuretic and widely used in cardiac surgery to reduce fluid overload, increase tubular flow and urine output. It remains unknown whether furosemide affects the incidence or prognosis of cardiac surgery‐induced acute kidney injury (CS‐AKI). Therefore, the current study was performed to address this question. Methods PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases were searched for relevant studies. Primary outcomes of interest included postoperative CS‐AKI incidence, need for renal replacement therapy (RRT) rate. Secondary outcomes of interest included postoperative serum creatinine (Scr) and blood urea nitrogen (BUN) levels, postoperative mechanical ventilation duration (MVD), length of stay (LOS) in intensive care unit (ICU) and in hospital, and mortality. The odds ratio (OR) and/or the weighted mean difference (WMD) with 95% confidence interval (CI) were used to pool the data. Results Database search yielded six studies including 566 adult patients, and 283 patients were allocated into Group Furosemide and 283 into Group Control (Placebo). Heterogeneity between studies was deemed acceptable, and the publication bias was low. Meta‐analysis suggested that furosemide administration in adult cardiac surgical patients had no effect on CS‐AKI incidence (n = 4 trials; OR = 0.92; 95% CI: 0.37–2.30; p = .86; I2 = 57%) and need for RRT rate (n = 2 trials; OR = 4.13; 95% CI: 0.44–38.51; p = .21; I2 = 0%). Diversely, furosemide administration in adult cardiac surgical patients significantly decreased postoperative BUN level (n = 3 trials; WMD = 0.71; 95% CI: 0.10–1.33; p = .02; I2 = 0%), postoperative MVD (n = 2 trials; WMD = −3.13; 95% CI: −3.78 to −2.49; p < .00001; I2 = 0%) and postoperative LOS in ICU (n = 3 trials; WMD = −0.47; 95% CI: −0.76 to −0.18; p = .001; I2 = 0%). However, it had no significant impact on postoperative Scr level, postoperative LOS in hospital, and postoperative mortality. Conclusion This meta‐analysis suggested that furosemide administration in adult cardiac surgical patients had no significant effect on CS‐AKI incidence, need for RRT rate, postoperative Scr level, LOS in hospital and mortality, but could reduce postoperative BUN level, MVD, and LOS in ICU. As only a limited number of studies were included, these results should be interpreted carefully and cautiously. Future high‐quality randomized controlled trials are needed to define the role of furosemide in CS‐AKI prevention and management.

show abstract

Renal and Cerebral Hypoxia and Inflammation During Cardiopulmonary Bypass

Jufar

Lankadeva

May

et al. 2021

Comprehensive Physiology

View full text Add to dashboard Cite

Cardiac surgery-associated acute kidney injury and brain injury remain common despite ongoing efforts to improve both the equipment and procedures deployed during cardiopulmonary bypass (CPB). The pathophysiology of injury of the kidney and brain during CPB is not completely understood. Nevertheless, renal (particularly in the medulla) and cerebral hypoxia and inflammation likely play critical roles. Multiple practical factors, including depth and mode of anesthesia, hemodilution, pump flow, and arterial pressure can influence oxygenation of the brain and kidney during CPB. Critically, these factors may have differential effects on these two vital organs. Systemic inflammatory pathways are activated during CPB through activation of the complement system, coagulation pathways, leukocytes, and the release of inflammatory cytokines. Local inflammation in the brain and kidney may be aggravated by ischemia (and thus hypoxia) and reperfusion (and thus oxidative stress) and activation of resident and infiltrating inflammatory cells. Various strategies, including manipulating perfusion conditions and administration of pharmacotherapies, could potentially be deployed to avoid or attenuate hypoxia and inflammation during CPB. Regarding manipulating perfusion conditions, based on experimental and clinical data, increasing standard pump flow and arterial pressure during CPB appears to offer the best hope to avoid hypoxia and injury, at least in the kidney. Pharmacological approaches, including use of anti-inflammatory agents such as dexmedetomidine and erythropoietin, have shown promise in preclinical models but have not been adequately tested in human trials. However, evidence for beneficial effects of corticosteroids on renal and neurological outcomes is lacking.

show abstract

Preoperative use of furosemide may increase the incidence of acute kidney injury after coronary artery bypass grafting: a propensity score-matched study

Cited by 6 publications

References 24 publications

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Furosemide does not reduce the incidence of postoperative acute kidney injury in adult patients undergoing cardiac surgery: A PRISMA‐compliant systematic review and meta‐analysis

Renal and Cerebral Hypoxia and Inflammation During Cardiopulmonary Bypass

Contact Info

Product

Resources

About