From the Guidelines
Furosemide (Lasix) can be prescribed to a patient with End-Stage Renal Disease (ESRD) on dialysis, but with caution and careful monitoring. When considering the use of diuretics in dialysis patients, it's essential to promote the loss of sodium and water, and large doses of potent loop diuretics like furosemide can be administered 1. However, the use of diuretics in this population should be approached with caution.
Key Considerations
- For patients with residual renal function, furosemide may help manage fluid overload between dialysis sessions, with typical dosing ranging from 80-160 mg twice daily.
- The medication should be administered after dialysis sessions since it will be removed during treatment.
- Effectiveness depends on residual kidney function, so patients with no urine output (anuria) will likely not benefit.
- Side effects to monitor include electrolyte imbalances, particularly potassium and sodium, which should be checked regularly.
Mechanism and Benefits
- Furosemide works by inhibiting sodium reabsorption in the loop of Henle, which requires some functioning nephrons to be effective.
- The medication may help reduce interdialytic weight gain, decrease blood pressure, and improve quality of life by reducing symptoms of fluid overload like shortness of breath and edema.
Individualized Dosing
- Dosing should be individualized based on the patient's response and residual urine output, with some patients requiring up to 500 mg daily. It's crucial to weigh the potential benefits of furosemide against the risks and carefully monitor patients for adverse effects, as the use of diuretics in ESRD patients on dialysis can be complex and requires careful management 1.
From the Research
Prescribing Lasix to ESRD Patients on Dialysis
- The use of diuretics, including Lasix (furosemide), in patients with End-Stage Renal Disease (ESRD) on dialysis is a complex issue 2.
- Loop diuretics, such as furosemide, are generally the agents of choice in ESRD, but may need to be used at higher doses due to pharmacokinetic changes in the context of diminishing renal clearance 2.
- Studies have shown that preserved residual renal function in dialysis patients is associated with improved patient survival, and diuretics may play a role in managing extracellular fluid volume and hypertension in these patients 2.
- However, the use of diuretics in ESRD patients on dialysis can also be associated with complications, such as dose-related ototoxicity and hyperkalemia 2.
- One study found that low and high doses of furosemide had no significant effects on central cardiac haemodynamics in anuric ESRD patients, suggesting that the use of furosemide infusion in these patients may not be supported 3.
- Another study suggested that combination therapy with low-dose metolazone and furosemide may be effective in managing refractory fluid overload in elderly renal failure patients under palliative care, but this may not be directly applicable to ESRD patients on dialysis 4.
- The decision to prescribe Lasix to an ESRD patient on dialysis should be made on a case-by-case basis, taking into account the individual patient's needs and medical history, as well as the potential benefits and risks of diuretic therapy 5, 6, 2.
Key Considerations
- The patient's residual renal function and ability to respond to diuretic therapy should be carefully evaluated 2.
- The potential benefits of diuretic therapy, including improved management of extracellular fluid volume and hypertension, should be weighed against the potential risks, including dose-related ototoxicity and hyperkalemia 2.
- Alternative therapies, such as combination therapy with metolazone and furosemide, may be considered in certain cases 4.
- Close monitoring of the patient's condition and adjustment of the treatment plan as needed is crucial to ensure optimal outcomes 5, 6, 2.