Featured Research

from universities, journals, and other organizations

Higher Death Rate And Non-Recovery Of Kidney Function Seen In ICU Patients Given Diuretics

Date:
November 28, 2002
Source:
University Of California - San Diego
Summary:
A substantially higher death rate and inability to recover from kidney failure was documented in a study of 552 critically ill, hospitalized patients who were given diuretics, the most commonly used therapy for kidney failure.

A substantially higher death rate and inability to recover from kidney failure was documented in a study of 552 critically ill, hospitalized patients who were given diuretics, the most commonly used therapy for kidney failure.

Related Articles


Published in the November 27, 2002 issue of the Journal of the American Medical Association (JAMA), the study suggests that physicians treating patients in acute kidney failure should reassess the use of diuretics, particularly when there is a limited response in terms of increased urine output.

A large percentage of patients who don't respond to diuretics may require dialysis, the use of a medical device to support kidney function by removing impurities that are usually eliminated by normal kidneys, said first author Ravindra Mehta, M.D., University of California, San Diego professor of medicine. He also noted that a delay in treatment, while physicians wait for diuretics to have an effect, can lead to numerous adverse medical outcomes.

The study was conducted over six years at four California hospitals by researchers at the UCSD School of Medicine and the University of California, San Francisco (UCSF).

Comparing kidney-failure patients who were prescribed diuretics to those who were not, researchers found that diuretic use was associated with a 68 percent increase in mortality and a 77 percent increase in the non-recovery of kidney function.

Diuretics are commonly prescribed to increase urine output in patients whose kidneys fail to produce enough urine, an indicator that harmful waste products are being retained, rather than filtered out by the kidneys. Previous studies have shown that 300,000-500,000 hospitalized patients in the U.S. develop kidney failure after admittance, making it a fairly common occurrence. Approximately 50-75 percent of these patients are traditionally given diuretics.

Noting that the JAMA paper describes an observational study, Mehta added that further investigations are needed to determine the direct causal link between diuretics and adverse outcomes.

The 552 patients studied had been admitted for a variety of medical conditions, and were then diagnosed with acute renal (kidney) failure in intensive care units at UCSD Medical Center, the San Diego Veterans Affairs Medical Center, San Diego Naval Hospital, and UC Irvine Medical Center from October 1989 to September 1995. Patients were followed from the time of initial consultation by a kidney specialist through hospital discharge or death. To compensate for variables, such as age, sex, race and additional disease or organ malfunction, the researchers used sophisticated statistical analysis to compare patients given diuretics to those who were not.

In addition to the increased mortality and non-recovery of kidney function, the investigators also found a variation in the time between consultation with a kidney specialist and the start of dialysis treatment, as physicians waited for a response to the diuretic therapy. "Delay in initiation of dialysis (waiting for a response to diuretics) may have untoward effects," the researchers said in the study. "These effects could include the worsening of respiratory, cardiovascular, central nervous system, and immune function due to volume overload and the effects of uremia."

An accompanying editorial in JAMA said the study is timely and clinically important because administration of diuretics to ICU patients in kidney failure is still a relatively common practice. "Until data from a sufficiently powered clinical trial can properly answer the question of whether critically ill patients are harmed by loop diuretics, the practice of routine administration of these agents to such patients should be discouraged," the editorial stated.

"This study illustrates that kidney failure is prevalent and too frequently under-diagnosed by ICU providers," Mehta said. "Kidney failure is dangerous and the longer it goes on, the likelihood of an adverse outcome increases. Physicians need to be aware that even small changes in kidney function can have deleterious effects. They need to recognize kidney failure early on and consider immediate dialysis as their first treatment of choice."

Additional authors were Glenn M. Chertow, M.D., MPH, UCSF, and Maria T. Pascual, R.N. and MPH, Sharon Soroko, M.S., UCSD Department of Medicine. The study was funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

Note: An additional study published by Mehta and others October 15, 2002 (Vol. 113) in the American Journal of Medicine used the same group of ICU patients to compare the relationship between the time a kidney specialist is consulted and the outcomes experienced by patients. The researchers found that delayed consultation was associated with increased mortality and worsening condition, whether or not dialysis was ultimately required. Mehta noted that this is another argument for immediate attention to kidney function in critically ill patients. This paper can be seen at the following website: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12427493&dopt=Abstract.


Story Source:

The above story is based on materials provided by University Of California - San Diego. Note: Materials may be edited for content and length.


Cite This Page:

University Of California - San Diego. "Higher Death Rate And Non-Recovery Of Kidney Function Seen In ICU Patients Given Diuretics." ScienceDaily. ScienceDaily, 28 November 2002. <www.sciencedaily.com/releases/2002/11/021127084758.htm>.
University Of California - San Diego. (2002, November 28). Higher Death Rate And Non-Recovery Of Kidney Function Seen In ICU Patients Given Diuretics. ScienceDaily. Retrieved November 28, 2014 from www.sciencedaily.com/releases/2002/11/021127084758.htm
University Of California - San Diego. "Higher Death Rate And Non-Recovery Of Kidney Function Seen In ICU Patients Given Diuretics." ScienceDaily. www.sciencedaily.com/releases/2002/11/021127084758.htm (accessed November 28, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Friday, November 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola Leaves Orphans Alone in Sierra Leone

Ebola Leaves Orphans Alone in Sierra Leone

AFP (Nov. 27, 2014) — The Ebola epidemic sweeping Sierra Leone is having a profound effect on the country's children, many of whom have been left without any family members to support them. Duration: 01:02 Video provided by AFP
Powered by NewsLook.com
Experimental Ebola Vaccine Shows Promise In Human Trial

Experimental Ebola Vaccine Shows Promise In Human Trial

Newsy (Nov. 27, 2014) — A recent test of a prototype Ebola vaccine generated an immune response to the disease in subjects. Video provided by Newsy
Powered by NewsLook.com
Pet Dogs to Be Used in Anti-Ageing Trial

Pet Dogs to Be Used in Anti-Ageing Trial

Reuters - Innovations Video Online (Nov. 26, 2014) — Researchers in the United States are preparing to discover whether a drug commonly used in human organ transplants can extend the lifespan and health quality of pet dogs. Video provided by Reuters
Powered by NewsLook.com
Today's Prostheses Are More Capable Than Ever

Today's Prostheses Are More Capable Than Ever

Newsy (Nov. 26, 2014) — Advances in prosthetics are making replacement body parts stronger and more lifelike than they’ve ever been. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins