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Common Kidney Therapy Harms More Than Helps

Diuretics tied to high death rate from organ failure

TUESDAY, Nov. 26, 2002 (HealthDayNews) -- Using diuretic drugs to increase urine output in patients with acute kidney disease, a common practice in the situation, can mask the signs of potentially fatal kidney failure, a California study finds.

The slight increase in urine output that results from the diuretic treatment can fool the physician into thinking that truly drastic measures, like an artificial kidney, are needed, a group led by Dr. Ravindra L. Mehta, professor of medicine at the University of California at San Diego, reports in tomorrow's Journal of the American Medical Association.

The study, which included 552 patients with acute renal -- kidney -- failure treated at four university intensive care units, found that the death rate for patients given diuretics was 77 percent higher than for those not given the drugs.

"Acute kidney failure often goes unrecognized," Mehta says. "The longer it goes unrecognized, the more likely the patient is to have a bad outcome. Depending on diuretics to augment urinary output can cloud the issue."

Acute kidney failure is not always easy to detect, and even small changes in function can lead to a bad outcome, Mehta says. The higher death rate was most notable in patients who had only a small response to the diuretics, he says.

"Our study suggests that if you don't get a good response, you shouldn't push it," he adds.

An accompanying editorial by Dr. Norbert Lameire and others at University Hospital in Ghent, Belgium, calls the study "timely and important" because the use of diuretics to increase urinary output for patients in intensive care units "is still 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 says.

The study results are "very disappointing" because "it says that one of the things we thought would help doesn't," says Dr. Darracott Vaughan, a professor of urology at Weill Cornell Medical Center in New York and a past president of the American Urological Association.

"A modality that we have thought for years might convert these people, push them into a recovery stage, did not," Vaughan says.

Despite all efforts, "we continue to have a very high morbidity and mortality with acute renal failure," he adds. "What is truly needed is basic research in understanding acute renal failure. We need to start all over again and see what will work."

What To Do

You can learn about your kidneys, how they work and how they fail, from the National Institute of Diabetes and Digestive and Kidney Disease or the National Kidney Foundation.

SOURCES: Ravindra L. Mehta, M.D., professor of medicine, University of California, San Diego; Darracott Vaughan, M.D., professor of urology, Weill Cornell Medical Center, New York ; Nov. 27, 2002 Journal of the American Medical Association
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