From the Guidelines
Lasix (furosemide) can be used cautiously in patients with a GFR of 25 ml/min, but dose adjustments are necessary. For patients with this level of kidney impairment, higher doses of furosemide are typically required to achieve the desired diuretic effect, as reduced kidney function impairs the medication's delivery to its site of action. A starting dose of 40-80 mg may be needed, with careful monitoring for response and side effects. When using Lasix in this setting, it's essential to closely monitor electrolytes (particularly potassium and sodium), kidney function, and fluid status. The medication should be titrated based on clinical response rather than using a fixed dose. Patients should be aware that Lasix may temporarily worsen kidney function parameters and can cause significant electrolyte disturbances. The rationale for using higher doses in reduced kidney function is that furosemide needs to reach adequate concentrations at the loop of Henle to inhibit sodium reabsorption, and kidney impairment reduces the amount of drug reaching this target site.
According to the most recent and highest quality study available, which is the 2014 study published in the American Journal of Kidney Diseases 1, caution should be exercised when prescribing medications, including diuretics like Lasix, in patients with chronic kidney disease (CKD). However, this study does not provide specific guidance on the use of Lasix in patients with a GFR of 25 ml/min.
In contrast, the 2009 study published in the Journal of the American College of Cardiology 1 and the 2009 study published in Circulation 1 provide guidance on the use of diuretics, including Lasix, in patients with heart failure, and suggest that loop diuretics like Lasix are effective even in patients with impaired renal function.
It's also worth noting that the 2005 study published in the Journal of the American College of Cardiology 1 provides similar guidance on the use of diuretics in patients with heart failure.
However, the most relevant study to this question is the 2014 study published in the American Journal of Kidney Diseases 1, which provides cautionary notes for prescribing in people with CKD, but does not specifically address the use of Lasix in patients with a GFR of 25 ml/min.
Therefore, based on the available evidence, the use of Lasix in patients with a GFR of 25 ml/min should be approached with caution, and dose adjustments should be made as necessary to achieve the desired diuretic effect while minimizing the risk of adverse effects.
Some key points to consider when using Lasix in patients with a GFR of 25 ml/min include:
- Higher doses of furosemide may be required to achieve the desired diuretic effect
- Close monitoring of electrolytes, kidney function, and fluid status is essential
- The medication should be titrated based on clinical response rather than using a fixed dose
- Patients should be aware of the potential for Lasix to temporarily worsen kidney function parameters and cause significant electrolyte disturbances.
From the FDA Drug Label
In patients with severe symptoms of urinary retention (because of bladder emptying disorders, prostatic hyperplasia, urethral narrowing), the administration of furosemide can cause acute urinary retention related to increased production and retention of urine. Reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency
The use of furosemide in patients with a GFR of 25 is not directly addressed in the provided drug label. However, it is mentioned that reversible elevations of BUN may occur and are associated with dehydration, which should be avoided, particularly in patients with renal insufficiency. Given the potential risks, it is recommended to exercise caution when using furosemide in patients with renal insufficiency, and careful monitoring of renal function is advised 2.
From the Research
Diuretic Therapy in Renal Failure
- The use of diuretics such as furosemide (Lasix) in patients with renal failure, particularly those with a glomerular filtration rate (GFR) of 25, is a complex issue that requires careful consideration of the patient's overall clinical condition 3, 4.
- Studies have shown that combination therapy with low-dose metolazone and furosemide can be effective in managing refractory fluid overload in elderly renal failure patients under palliative care, with improvements in clinical congestion and body weight reduction 3.
- However, the use of diuretics in patients with advanced renal failure must be carefully monitored to avoid adverse effects such as electrolyte disturbances and worsening renal function 4, 5.
Furosemide Dosage and Administration
- The dosage and administration of furosemide in patients with renal failure may need to be adjusted to achieve optimal diuretic response while minimizing adverse effects 6, 7.
- Continuous infusion of furosemide has been shown to be effective in patients with congestive heart failure and diuretic resistance, with significant weight loss and relief of symptoms 6.
- Comparison of bumetanide- and metolazone-based diuretic regimens to furosemide in acute heart failure has shown that combination therapy with metolazone may be associated with greater increases in urine output, but also with a higher incidence of electrolyte abnormalities 7.
Considerations for Patients with GFR 25
- Patients with a GFR of 25 have significant renal impairment and may require careful adjustment of diuretic dosage and monitoring of renal function and electrolyte levels 4, 5.
- The use of diuretics such as furosemide in these patients must be individualized and based on careful consideration of the patient's overall clinical condition, including the presence of fluid overload, electrolyte disturbances, and other comorbidities 3, 6, 7.