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March 19, 2003

Diuretics in Critically Ill Patients With Acute Renal FailureDiuretics in Critically Ill Patients With Acute Renal Failure

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(11):1379-1381. doi:10.1001/jama.289.11.1379-a

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.

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