Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
To the Editor: Dr Mehta and colleagues1 suggested that the adverse outcome of diuretic
use in patients with ARF is related either to a direct effect of diuretics
or a delay in initiating dialysis. We are concerned that the results do not
justify either of these conclusions.
As shown in Figure 2, higher mortality rates occurred in the patients
given diuretics, but who were diuretic resistant (furosemide equivalent per
milliliter ratio ≥1.0). Mortality rates were similar, however, for the
no diuretic and diuretic-responsive groups. Thus, oliguric ARF had a poorer
outcome than nonoliguric ARF. Failure to respond to diuretics reflects severe
renal disease; the poor outcome in this group reflects the poorer prognosis
of oliguric ARF.2 No direct causal effect
between diuretic use and poor outcome can be inferred from these results.
Unnikrishnan D, Lanewala A, Krishnan S. Diuretics in Critically Ill Patients With Acute Renal FailureDiuretics in Critically Ill Patients With Acute Renal Failure. JAMA. 2003;289(11):1379-1381. doi:10.1001/jama.289.11.1379-a