From the Guidelines
Furosemide can be used to treat volume overload and pulmonary edema in dialysis patients, even after they have received a dialysis treatment, as suggested by the KDIGO practice guideline on acute kidney injury 1.
Key Considerations
- The medication works by inhibiting sodium and chloride reabsorption in the kidneys, promoting diuresis even in patients with significantly impaired kidney function.
- For acute pulmonary edema, an initial IV dose of 40-80 mg furosemide is typically given, which can be increased to 100-200 mg if needed based on response, as per the European Society of Cardiology guidelines 1.
- In dialysis patients, higher doses are often required due to decreased renal function.
- It's essential to monitor the patient's fluid status, electrolytes (particularly potassium), and blood pressure when administering furosemide, as these patients are already at risk for electrolyte abnormalities.
- The use of furosemide should be carefully titrated to promote effective diuresis while avoiding worsening renal function, as highlighted in the Annals of Emergency Medicine study 1.
Important Points to Note
- Furosemide is not a replacement for dialysis but can be a useful adjunct therapy for managing acute volume-related symptoms.
- Continuous furosemide infusion might be considered for persistent volume overload.
- The potential safety considerations regarding diuretic administration, including the association between diuretic use and worsening renal function, should be taken into account when dosing furosemide 1.
From the FDA Drug Label
Furosemide is indicated in adults and pediatric patients for the treatment of edema associated with congestive heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrome Furosemide is particularly useful when an agent with greater diuretic potential is desired. Furosemide is indicated as adjunctive therapy in acute pulmonary edema. The intravenous administration of furosemide is indicated when a rapid onset of diuresis is desired, e.g., in acute pulmonary edema.
Yes, furosemide can be used to treat volume overload and pulmonary edema after a patient on dialysis receives one, as it is indicated for the treatment of edema associated with renal disease and as adjunctive therapy in acute pulmonary edema 2.
From the Research
Volume Overload and Pulmonary Edema Treatment
- Volume overload is a common complication in end-stage renal disease (ESRD) patients, and it is directly related to numerous complications including resistant hypertension, cardiac hypertrophy, congestive heart failure, or arterial stiffness, among others 3.
- Fluid overload not only causes unpleasant symptomatology for patients on dialysis, but also leads to increased incidence of hospitalization and mortality 4.
- Diuretics are the cornerstone of therapy for volume overload, with loop diuretics being the first-line treatment in the management of hypervolemia 5.
Furosemide as a Treatment Option
- Furosemide is a loop diuretic that can be used to treat volume overload and pulmonary edema 5.
- However, there is no direct evidence in the provided studies that specifically mentions the use of furosemide in patients on dialysis who receive a transplant.
- Nondialytic management, including diuretics, can be instituted immediately in the management of hyperkalemia and congestive heart failure in ESRD patients, but the decision to use nondialytic management alone should be made on a case-by-case basis 6.
Assessment of Volume Status
- Relying solely on clinical examination for assessing volume overload in ESRD patients lacks sensitivity and specificity 3.
- Numerous methods, including biomarkers, inferior vena cava assessment, lung ultrasonography, bioimpedance analysis, and blood volume monitoring, can be used to assess volume status, but each method has its own limitations 3, 7.