[Renaliste] diurese d 'entrainement

[ryckelynck-jp]

Voici un abstract d'un autre article correspondant à une étude multicentrique français exclusivement dans l'insuffisance rénale aigüe (AJKD Volume 44, Issue 3, Pages 402-409 September 2004)
 
A priori, cela a un effet favorable si lIRA est à diurèse conservée mais cela n'améliore en rien les chances de récupération de la fonction rénale.

JPh Ryckelynck 
 
 
 High-dose furosemide for established ARF: A prospective, randomized, double-blind, placebo-controlled, multicenter trial
Félix Cantarovich, MDa, Badrudin Rangoonwala, PhDb, Horst Lorenz, DiplMathc, Matti Verho, MDd, Vincent L.M. Esnault, MD, PhDe

Received 5 January 2004; accepted 20 May 2004

Background: The effect of furosemide on the survival and renal recovery of patients presenting with acute renal failure (ARF) is still debated. Methods: Three hundred thirty-eight patients with ARF requiring dialysis therapy were randomly assigned to the administration of either furosemide (25 mg/kg/d intravenously or 35 mg/kg/d orally) or matched placebo, with stratification according to severity at presentation. The primary end point was survival. The secondary end point was number of dialysis sessions. Tertiary end points included time on dialysis therapy, time to achieve a serum creatinine level less than 2.26 mg/dL (<200 ?mol/L), and time to reach a 2-L/d diuresis. Results: There were no differences in survival and renal recovery rates between the 2 groups. Time to achieve a 2-L/d diuresis was shorter with furosemide (5.7 ± 5.8 days) than placebo (7.8 ± 6.8 days; P = 0.004). Overall, 148 patients achieved a urine output of at least 2 L/d during the study period (94 of 166 patients; 57%) with furosemide versus 54 of 164 patients (33%) with placebo (P < 0.001). However, there were no significant differences in number of dialysis sessions and time on dialysis therapy between the furosemide and placebo groups, even in the subgroup of patients reaching a 2-L/d diuresis. Conclusion: High-dose furosemide helps maintain urinary output, but does not have an impact on the survival and renal recovery rate of patients with established ARF.

Index words: Loop diuretics, acute renal failure (ARF), Simplified Acute Physiology Scores (SAPS), furosemide, randomized placebo-controlled trial
a Department of Transplantation and Intensive Care, Necker Hospital, Paris, France

b Department of Pharmacology, Ulm University, Ulm, Germany

c Bûro fu?r Biometrie und Statistik, Neuberg, Germany

d Mitsubishi Pharma, London, England

e Nephrology and Clinical Immunology Department, Nantes University Hospital, Nantes, France

Address reprint requests to Félix Cantarovich, MD, Service de Transplantation et Réanimation, Hôpital Necker, 161 rue de Sèvres, 75743 Paris, France

 Supported in part by an unrestricted grant from Aventis Pharmaceuticals. B.R. and M.V. were employees of Aventis Pharmaceuticals at the time of study initiation.

PII: S0272-6386(04)00810-8

doi:10.1053/j.ajkd.2004.05.021

© 2004 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
 

-----Message d'origine-----
De : renaliste-bounces at nephrodial.org
[mailto:renaliste-bounces at nephrodial.org]De la part de Dan Teboulle
Envoyé : lun. 9 octobre 2006 17:57
À : Liste de discussion des néphrologues francophones
Objet : [Renaliste] diurese d 'entrainement


Message de la liste nephrologique francophone RENALISTE
----------------------------------
Depuis de longues années le furosémide est prescrit dans de nombreux 
services d'urgence ou de réanimation pour prévenir ou traiter des 
insuffisances rénales aiguës , ou insuffisance rénale chronique modérée 
associée, associée à d'autres pathologies...
la fameuse diurese forcée ou d 'entrainement apporte t elle un bénéfice 
quelconque...?
ne cache t elle pas , parfois , une évolution naturelle qui sera alors 
difficile à évaluer..?
est elle toxique ? pour le rein?

les néphrologues ont à ce sujet des habitudes différentes, il me semble...
qu'en pensez vous....

dan teboulle
chg mont de marsan 

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