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The role of diuretics in the prevention and treatment of AKI has already been discussed in Chapter 3.4. Only one RCT has evaluated the potential role of diuretics in resolving AKI in patients receiving RRT. After the end of the CVVH session, the urine of the first 4 hours was collected for measuring CrCl. Seventy one patients were subsequently randomized to receive furosemide (0.5 mg/kg/h) or placebo by continuous infusion, continued until CrCl reached 30 ml/min. Urinary fluid losses were compensated by i.v. infusion. The primary end-point was renal recovery (CrCl > 30 ml/min or stable SCr without RRT) in the ICU and in the hospital. CVVH was restarted based on predefined criteria. Patients treated with furosemide (n = 36) had a significantly increased urinary volume and greater sodium excretion compared to placebo-treated patients (n = 35). However, there were no differences in need for repeated CVVH, or renal recovery during ICU or hospital stay.195 An observational study of discontinuation of RRT also found no difference in diuretic use between patents with successful or unsuccessful discontinuation of IHD.568 In summary, diuretics may improve urine volume after RRT, but do not appear to have any significant benefit in reducing the need for RRTor promoting renal recovery from AKI.
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