From the Guidelines
Lasix (furosemide) is indicated in patients with Chronic Kidney Disease (CKD) for managing fluid overload, edema, and hypertension, but its use requires careful monitoring due to the potential for worsening kidney function and electrolyte imbalances, as highlighted in the 2018 study published in the British Journal of Pharmacology 1.
Key Considerations
- The medication works as a loop diuretic, inhibiting sodium and chloride reabsorption in the ascending loop of Henle, promoting diuresis even when glomerular filtration rate is reduced.
- For CKD patients, dosing typically starts at 20-40mg once or twice daily, with potential increases up to 80-120mg per dose in advanced CKD, as these patients often develop diuretic resistance 1.
- Higher doses may be needed as kidney function declines, and intravenous administration might be necessary in severe cases.
Monitoring and Precautions
- Careful monitoring is essential, including regular assessment of electrolytes (particularly potassium, sodium, and magnesium), kidney function, blood pressure, and volume status.
- Potential side effects include electrolyte imbalances, dehydration, and further acute kidney injury if excessive diuresis occurs.
- The 2018 study emphasizes the importance of monitoring renal function in patients with heart failure, particularly those on loop diuretics like furosemide, due to the risk of renal decline and increased mortality rate 1.
Comprehensive Treatment Approach
- Lasix should be used judiciously in CKD, balancing the need for fluid removal against the risk of worsening kidney function.
- It is often used as part of a comprehensive treatment approach that may include dietary sodium restriction and other medications for blood pressure control.
- The study highlights the need for stringent monitoring systems, particularly in patients with CKD, to minimize the risks associated with loop diuretic use 1.
From the FDA Drug Label
Furosemide tablets are indicated in adults and pediatric patients for the treatment of edema associated with ... renal disease, The FDA drug label indicates Furosemide (Lasix) is used for the treatment of edema associated with renal disease.
- Key Point: Furosemide can be used in patients with Chronic Kidney Disease (CKD) for the treatment of edema. 2
From the Research
Indications for Lasix in CKD
- Lasix (furosemide) is a loop diuretic that can be used in patients with Chronic Kidney Disease (CKD) to manage excess extracellular fluid 3.
- The use of diuretics, including loop diuretics like furosemide, is important in CKD to control extracellular fluid volume, reduce protein excretion in urine, and prevent hyperkalemia 3.
- In patients with refractory fluid overload, combination therapy with low-dose metolazone and furosemide may be effective in managing fluid overload without the need for parenteral diuretics 4.
Comparison with Other Diuretics
- Furosemide and bumetanide are both loop diuretics that can be used in patients with CKD, but they may have different pharmacokinetic and pharmacodynamic characteristics 5.
- Studies have shown that furosemide may be more effective than bumetanide in producing a maximal diuretic response in patients with chronic renal insufficiency 5.
Considerations for Use
- The use of diuretics in CKD requires careful monitoring of electrolyte levels and fluid status to avoid adverse events 3.
- The dose and frequency of diuretic administration may need to be adjusted in patients with CKD to achieve optimal fluid management 3.
- Further studies are needed to determine the optimal use of diuretics, including furosemide, in patients with advanced CKD [(6,7)].