From the Guidelines
Furosemide (Lasix) can be given to patients with Chronic Kidney Disease (CKD) who have no urine output, but its effectiveness is significantly reduced and requires careful consideration. In patients with anuria (no urine output), furosemide is generally not recommended as a first-line treatment since its primary mechanism of action requires functioning nephrons to inhibit sodium reabsorption in the loop of Henle 1. For CKD patients with oliguria or anuria, higher doses of furosemide (80-160mg or more) may be needed, and the medication should be administered intravenously rather than orally for better bioavailability.
The decision to use furosemide in these patients should be based on a thorough assessment of volume status, electrolyte levels, and remaining kidney function. Potential risks include electrolyte imbalances (particularly hypokalemia), ototoxicity at high doses, and further kidney injury. According to the ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012, loop diuretics like furosemide produce a more intense and shorter diuresis than thiazides, which cause a more gentle and prolonged diuresis 1.
Key considerations for using furosemide in CKD patients with no urine output include:
- Close monitoring of fluid status, electrolytes, and kidney function parameters to ensure safety and assess effectiveness
- Alternative approaches for fluid management, such as ultrafiltration or dialysis, may be necessary
- The aim of using diuretics is to achieve and maintain euvolaemia (the patient’s ‘dry weight’) with the lowest achievable dose, which may require adjusting the dose of furosemide particularly after restoration of dry body weight, to avoid the risk of dehydration leading to hypotension and renal dysfunction 1.
Overall, the use of furosemide in CKD patients with no urine output requires careful consideration of the potential benefits and risks, and should be guided by the patient's individual clinical needs and response to treatment.
From the Research
Administration of Lasix in CKD Patients with No Urine Output
- The use of loop diuretics, such as furosemide (Lasix), in patients with chronic kidney disease (CKD) is a topic of interest, particularly in those with no urine output 2.
- According to a study published in 1992, loop diuretics may be given to control extracellular volume expansion responsible for hypertension in patients with CKD, but their use is mostly helpful when impaired renal function co-exists with nephrotic syndrome or chronic heart failure 2.
- In patients with oliguric form of acute renal failure (ARF), loop diuretics may increase sodium excretion and urine output, but they do not affect the mortality rate for ARF 2.
- There is no direct evidence to suggest that Lasix can be given to patients with CKD and no urine output, as the studies primarily focus on patients with some level of urine output or those undergoing dialysis.
- However, a study published in 2014 suggests 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, even if they are not producing urine 3.
- Another study published in 1980 found that the combination of furosemide and metolazone is highly effective in treating severe fluid retention, and may simplify the treatment of fluid retention by avoiding high doses of furosemide 4.
Key Considerations
- The use of Lasix in CKD patients with no urine output should be approached with caution, as there is limited evidence to support its effectiveness in this population.
- Combination therapy with metolazone and furosemide may be a potential alternative for managing fluid overload in CKD patients, but further research is needed to confirm its safety and efficacy 3, 4.
- The prevention of contrast nephropathy by furosemide with matched hydration has been studied, and the results suggest that this approach may be effective in reducing the risk of contrast-induced nephropathy in patients with CKD undergoing coronary procedures 5.