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Diuretics are frequently used in patients at risk of AKI, and in the management of those who develop AKI. Since fluid overload is one of the major symptoms of AKI, diuretics are often used for patients with AKI to facilitate fluid management. Recent observational studies showed that 59–70% of patients with AKI were given diuretics at the time of nephrology consultation or before the start of RRT.181,182 In addition, oliguric AKI has a worse prognosis than nonoliguric AKI and physicians often prescribe diuretics to convert oliguric to nonoliguric AKI.183 Diuretics are also used to control fluid balance and permit administration of nutrition and medications. Furthermore, several diuretics have potentially renoprotective effects that might prevent development of AKI and hasten its recovery. However, diuretics can also be harmful, by reducing the circulating volume excessively and adding a prerenal insult, worsening established AKI. Therefore, it is essential to evaluate usefulness of diuretics to improve outcome of patients with AKI, not just for fluid management.
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