Bagshaw Sean M, Delaney Anthony, Jones Daryl, Ronco Claudio, Bellomo Rinaldo
Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alta., Canada.
Contrib Nephrol. 2007;156:236-49. doi: 10.1159/000102089.
Diuretics are a common intervention in critically ill patients with acute kidney injury (AKI). However, there is no information that describes the practice patterns of diuretic use by clinicians.
Multinational, multicenter survey of intensive care and nephrology clinicians that utilized an 18-question self-reported questionnaire.
The survey generated 331 responses from 16 countries. Academic institutions comprised 77.5%, with the remaining being from metropolitan, regional or private hospitals. The use of furosemide was most common (67.1%), delivered primarily intravenously (71.9%) and by bolus dosing (43.3%). Other diuretics were infrequently used. The majority rated current serum creatinine (73.6%) and urine output (73.4%), blood pressure (59.7%), central venous pressure (65.2%) and risk of toxicity (62.4%) important when deciding on a dose. Pulmonary edema was a prime physiologic indication for diuretic use (86.3%). Diuretic use was also common with rhabdomyolysis (55.6%), major surgery (56%), and cardiogenic shock (56.2%), and sepsis (49.5%). Diuretic use was most commonly given either prior to (57.7%) or during recovery (33.9%) after renal replacement therapy (RRT). Most (76.6%) targeted a diuresis of >or=0.5-1.0 ml/kg/h. The majority did not believe that diuretics could reduce mortality (74.3%), reduce need for (50.8%) or duration of RRT (57.8%) or improve renal recovery (68.2%), however, many stated uncertainty. Most (85.1%) would be willing to participate in a randomized trial (RCT) of diuretics in AKI with 72.4% believing it ethically acceptable to allocate patients to placebo.
Diuretics are frequently used in AKI. Clinicians are most familiar with furosemide given intravenously and titrated to a physiologic endpoint of urine output. Most clinicians believe an RCT on diuretic use in AKI is justified and ethical. This survey confirms clinical agreement and a need for higher quality evidence on diuretic use in AKI.
利尿剂是急性肾损伤（AKI）重症患者的常见干预措施。然而，尚无描述临床医生使用利尿剂的实践模式的信息。
对重症监护和肾脏病临床医生进行多国多中心调查，采用一份包含18个问题的自填式问卷。
该调查收到了来自16个国家的331份回复。学术机构占77.5%，其余来自大城市、地区或私立医院。呋塞米的使用最为常见（67.1%），主要通过静脉给药（71.9%）和推注给药（43.3%）。其他利尿剂使用较少。大多数人认为，在决定剂量时，当前血清肌酐水平（73.6%）、尿量（73.4%）、血压（59.7%）、中心静脉压（65.2%）和毒性风险（62.4%）很重要。肺水肿是使用利尿剂的主要生理指征（86.3%）。在横纹肌溶解症（55.6%）、大手术（56%）、心源性休克（56.2%）和脓毒症（49.5%）患者中，利尿剂的使用也很常见。利尿剂最常在肾脏替代治疗（RRT）之前（57.7%）或恢复期间（33.9%）使用。大多数（76.6%）的目标尿量为≥0·5 - 1·0 ml/kg/h。大多数人认为利尿剂不能降低死亡率（74.3%）、减少RRT的需求（50.8%）或持续时间（57.8%），也不能改善肾脏恢复情况（68.2%），不过，许多人表示不确定。大多数（85.1%）愿意参与AKI患者利尿剂的随机试验（RCT），72.4%的人认为将患者分配到安慰剂组在伦理上是可以接受的。
利尿剂在AKI中经常使用。临床医生最熟悉静脉注射呋塞米并根据尿量的生理终点进行滴定。大多数临床医生认为，关于AKI患者使用利尿剂的RCT是合理且符合伦理的。这项调查证实了临床共识以及对AKI患者使用利尿剂的更高质量证据的需求。
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