Vargas Hein Ortrud, Staegemann M, Wagner D, von Heymann C, Martin M, Morgera S, Spies C
Department of Anesthesiology and Intensive Care, University Hospital Charité, Berlin, Germany.
Ren Fail. 2005;27(4):385-92. doi: 10.1081/jdi-65298.
Diuretic therapy in ARF (acute renal failure) is mainly done with loop diuretics, first of all furosemide. Torsemide has a longer duration of action and does not accumulate in renal failure. In chronic and acute renal failure, both diuretics have been effectively applied, with a more pronounced diuretic effect for torsemide. In this study, the effects of torsemide versus furosemide on renal function in cardiac surgery patients recovering from ARF after continuous renal replacement therapy (CRRT) were studied. Twenty-nine critically ill patients admitted to an intensive care unit at a university teaching hospital after cardiac surgery recovering from ARF after CRRT were included in this prospective, controlled, single-center, open-labeled, randomized clinical trial. Inclusion criteria were urine output >0.5 mL/kg/h over 6 h under CRRT. Torsemide and furosemide dosages were adjusted with the target urine output being 0.8-1.5 mL/kg/h. Hemodynamic data, urine output, volume balance, serum creatinine clearance, electrolytes, blood urea nitrogen, serum creatinine, renin, and aldosterone concentrations were measured. Fourteen patients were included in the furosemide group and 15 patients in the torsemide group. Dosages of 29 (0-160) mg torsemide and a dosage of 60 (0-240) mg furosemide were given every 6 h in each group, respectively. The dosage given at the end of the study decreased significantly in furosemide and torsemide treated patients. Urine output, 24 h balance, and serum creatinine clearance did not differ significantly between groups. Urine output decreased in both groups, mostly dose-dependent in the torsemide group. The intragroup comparison of the first time-interval after inclusion with the last time-interval showed a significant increase in serum creatinine and blood urea nitrogen in the furosemide group. Renin and aldosterone concentrations did not show significant differences. In conclusion, torsemide and furosemide were effective in increasing urine output. Torsemide might show a better dose-dependent diuretic effect in ARF patients after CRRT treatment. Serum creatinine and blood urea nitrogen elimination were less pronounced in the furosemide group.
急性肾衰竭（ARF）的利尿治疗主要使用袢利尿剂，首先是呋塞米。托拉塞米作用持续时间更长，且在肾衰竭时不会蓄积。在慢性和急性肾衰竭中，这两种利尿剂均得到有效应用，托拉塞米的利尿效果更为显著。本研究探讨了托拉塞米与呋塞米对心脏手术患者在接受持续肾脏替代治疗（CRRT）后从ARF恢复过程中肾功能的影响。本前瞻性、对照、单中心、开放标签、随机临床试验纳入了一所大学教学医院重症监护病房收治的29例心脏手术后从ARF恢复且接受CRRT的重症患者。纳入标准为CRRT下6小时尿量>0.5 mL/kg/h。根据目标尿量0.8 - 1.5 mL/kg/h调整托拉塞米和呋塞米剂量。测量血流动力学数据、尿量、容量平衡、血清肌酐清除率、电解质、血尿素氮、血清肌酐、肾素和醛固酮浓度。呋塞米组纳入14例患者，托拉塞米组纳入15例患者。每组分别每6小时给予托拉塞米剂量为29（0 - 160）mg和呋塞米剂量为60（0 - 240）mg。研究结束时给予的剂量在呋塞米和托拉塞米治疗患者中均显著降低。两组间尿量、24小时平衡和血清肌酐清除率无显著差异。两组尿量均减少，托拉塞米组大多呈剂量依赖性。呋塞米组纳入后首个时间间隔与最后一个时间间隔的组内比较显示血清肌酐和血尿素氮显著升高。肾素和醛固酮浓度无显著差异。总之，托拉塞米和呋塞米在增加尿量方面均有效。托拉塞米在CRRT治疗后的ARF患者中可能表现出更好的剂量依赖性利尿效果。呋塞米组血清肌酐和血尿素氮清除效果较差。
