Meta-analysis of frusemide to prevent or treat acute renal failure

Abstract

Objective: To investigate the potential beneficial and adverse effects of frusemide to prevent or treat acute renal failure in adults.

Design: Meta-analysis of randomised controlled trials.

Data sources: Cochrane controlled trials register (2005 issue 4), Embase, and Medline (1966 to 1 February 2006), without language restrictions.

Review methods: Two reviewers checked the quality of the studies and independently extracted data.

Results: Nine randomised controlled trials totalling 849 patients with or at risk of acute renal failure were included. Outcome measures not significantly different after frusemide treatment were in-hospital mortality (relative risk 1.11, 95% confidence interval 0.92 to 1.33), risk for requiring renal replacement therapy or dialysis (0.99, 0.80 to 1.22), number of dialysis sessions required (weight mean difference--0.48 sessions, -1.45 to 0.50), and proportion of patients with persistent oliguria (urine output < 500 ml/day: 0.54, 0.18 to 1.61). Stratifying studies that used frusemide to prevent or treat acute renal failure did not change the results on mortality (relative risk ratio 2.10, 95% confidence interval 0.67 to 6.63) and the risk for requiring dialysis (4.12, 0.46 to 37.2). Evidence suggested an increased risk of temporary deafness and tinnitus in patients treated with high doses of frusemide (relative risk 3.97, 95% confidence interval 1.00 to 15.78).

Conclusions: Frusemide is not associated with any significant clinical benefits in the prevention and treatment of acute renal failure in adults. High doses may be associated with an increased risk of ototoxicity.

Fig 1

Flow of studies in meta-analysis

Fig 2

Effect of frusemide on in-hospital mortality and proportion of patients requiring renal replacement therapy or dialysis

Fig 3

Number of dialysis sessions required after frusemide or control treatments. NA=not available

Fig 4

Proportion of patients remaining oliguric (urine output <500 ml/day) after frusemide or control treatments and those mentioning tinnitus or deafness

Fig 5

Funnel plot showing possibility of small publication bias (broken lines show overall effect and 95% confidence intervals)