Is furosemide (Lasix) still administered in cases of anuria (Impaired renal function)?

From the Guidelines

Furosemide (Lasix) is not recommended for patients who are anuric, as it is unlikely to be effective in increasing urine output in the absence of functioning nephrons. In anuria, where urine production has completely ceased, diuretics like furosemide cannot effectively work since they require functioning nephrons to increase urine output 1. Administering Lasix to an anuric patient is unlikely to restore urine production and may potentially cause harm through side effects such as electrolyte imbalances without providing benefit.

Key Considerations

• The most recent guidelines from 2022 emphasize the importance of tailoring diuretic therapy to the individual patient's needs, taking into account factors such as renal function and the presence of diuretic resistance 1.
• Diuretic resistance can be overcome in several ways, including escalation of loop diuretic dose, intravenous administration of diuretics (bolus or continuous infusion), or combination of different diuretic classes 1.
• However, in the case of anuria, these strategies are unlikely to be effective, and management should focus on addressing the underlying cause of anuria.

Management of Anuria

• Instead of administering diuretics, management should focus on addressing the underlying cause of anuria, which might include renal replacement therapy like hemodialysis or continuous renal replacement therapy (CRRT) if appropriate.
• If the patient has acute kidney injury with anuria, treating the underlying cause and providing supportive care is more appropriate than continuing diuretic therapy.
• The exception would be in specific situations where high-dose furosemide (typically 160-200mg IV) might be used as a diagnostic challenge to determine if the anuria is potentially reversible, but this should only be done under specialist guidance.

From the FDA Drug Label

Furosemide tablets are contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.

• No, we should not give Lasix (furosemide) in case the patient is anuric, as it is contraindicated in such patients 2.

From the Research

Use of Lasix in Anuric Patients

• The use of loop diuretics, such as Lasix (furosemide), in anuric patients is a topic of debate 3, 4.
• In patients with chronic renal failure, loop diuretics may be given to control extracellular volume expansion responsible for hypertension, but their use is mostly helpful when impaired renal function co-exists with nephrotic syndrome or chronic heart failure 3.
• In anuric patients, the use of diuretics is often stopped when patients commence dialysis, but some studies suggest 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 4.
• However, the use of high doses of furosemide in anuric patients has been shown to have no significant effects on central cardiac haemodynamics, and its use in anuric ESRD patients with acute pulmonary oedema is not supported by some studies 5.

Clinical Considerations

• The decision to use Lasix in anuric patients should be made on a case-by-case basis, taking into account the patient's individual needs and medical history 4.
• Loop diuretics, such as Lasix, may still be used in anuric patients to manage extracellular fluid volume and hypertension, but their use should be carefully monitored to avoid potential complications, such as ototoxicity and hyperkalemia 4.
• The use of diuretics in anuric patients may be beneficial in reducing the tendency to hyperkalemia, but their effectiveness in managing fluid balance and blood pressure may be limited 3, 4.