The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study)

Bagshaw, Sean M., Gibney, R.T. Noel, Kruger, Peter, Hassan, Imran, McAlister, Finlay A. and Bellomo, Rinaldo (2017) The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study). Journal of Critical Care, 42 138-146. doi:10.1016/j.jcrc.2017.07.030


Author Bagshaw, Sean M.
Gibney, R.T. Noel
Kruger, Peter
Hassan, Imran
McAlister, Finlay A.
Bellomo, Rinaldo
Title The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study)
Journal name Journal of Critical Care   Check publisher's open access policy
ISSN 1557-8615
0883-9441
Publication date 2017-07-12
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.jcrc.2017.07.030
Open Access Status Not yet assessed
Volume 42
Start page 138
End page 146
Total pages 9
Place of publication Maryland Heights, United States
Publisher W.B. Saunders
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract Purpose Furosemide is commonly prescribed in acute kidney injury (AKI). Prior studies have found conflicting findings on whether furosemide modifies the course and outcome of AKI. Methods Pilot multi-center randomized blinded placebo-controlled trial in adult patients with AKI admitted to three intensive care units. Participants were randomly allocated to furosemide bolus and infusion or 0.9% saline placebo. Primary endpoint was worsening AKI, defined by the RIFLE criteria. Secondary endpoints were kidney recovery, renal replacement therapy (RRT) and adverse events. Results The trial was terminated after enrollment of 73 participants (37 to furosemide and 36 to placebo). Mean (SD) age was 61.7 (14.3), 79.5% were medical admissions, mean (SD) APACHE II score was 26.6 (7.8), 90.4% received mechanical ventilation and 61.6% received vasoactives. 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 RRT (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. Conclusions In this pilot trial, furosemide did not reduce the rate of worsening AKI, improve recovery or reduce RRT; however, was associated with greater electrolyte abnormalities. Trial registration ClinicalTrials.gov Identifier: NCT00978354 registered September 9, 2014.
Keyword Acute kidney injury
Furosemide
Mortality
Placebo
Randomized
Recovery
Renal replacement therapy
Urine output
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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Created: Sun, 24 Dec 2017, 01:23:14 EST