Trial of Furosemide to Prevent Acute Kidney Injury in Critically Ill Children: A Double-Blind, Randomized, Controlled Trial.
Trial of Furosemide to Prevent Acute Kidney Injury in Critically Ill Children: A Double-Blind, Randomized, Controlled Trial.
复制标题
DOI：
10.1007/s12098-021-03727-3
复制
发表时间：
2021-11
影响因子：
4.3
通讯作者：
Mahadevan S
中科院分区：
文献类型：
--
作者：
Abraham S;Rameshkumar R;Chidambaram M;Soundravally R;Subramani S;Bhowmick R;Sheriff A;Maulik K;Mahadevan S
研究与安慰剂相比，重症儿童早发性急性肾损伤（阿基）中呋塞米输注是否与进展至更高阶段（损伤或衰竭）的患者比例降低相关。进行了一项双盲、安慰剂对照、随机化初步试验。作者招募了年龄为1个月（校正）至12岁的儿童，这些儿童使用儿科风险、损伤、衰竭、丧失、终末期肾病（p-RIFLE）标准诊断为阿基（“风险”期），并在入院后24小时内实现了立即复苏目标。参与者接受呋塞米（0.05至0.4 mg/kg/h）或安慰剂（5%葡萄糖）输注。主要结局是进展到更高阶段（损伤或失败）的患者比例。次要结局为（i）是否需要肾脏替代治疗，（ii）对中性粒细胞明胶酶相关脂质运载蛋白（尿液和血液）的影响，（iii）液体平衡，（iv）不良反应，（v）达到肾脏恢复的时间，（vi）住院和机械通气的持续时间，（vii）28天全因死亡率。试验因无效而停止，并在意向治疗的基础上分析数据（呋塞米组：n = 38;安慰剂组：n = 37）。呋塞米组和安慰剂组之间阿基进展至更高阶段的差异无统计学意义（10.5% vs. 21.6%;相对风险= 0.49，95% CI 0.16 - 1.48）（p = 0.22）。研究组之间的次要结局无差异。两组之间的全因28天死亡率相似（10.5% vs. 10.8%）。未发生试验相关严重不良事件。在早发性阿基中输注呋塞米并不能减少阿基向更高阶段的进展。未来需要进行大样本量的试验。
To study whether furosemide infusion in early-onset acute kidney injury (AKI) in critically ill children would be associated with a reduced proportion of patients progressing to the higher stage (Injury or Failure) as compared to placebo. A double-blind, placebo-controlled, randomized pilot trial was conducted. The authors enrolled children aged 1-mo (corrected) to 12-y, who were diagnosed with AKI (“risk” stage) using pediatric-Risk, Injury, Failure, Loss, End stage kidney disease (p-RIFLE) criteria, and achieved immediate resuscitation goals within 24 h of admission. Participants received either furosemide (0.05 to 0.4 mg/kg/h) or placebo (5%-dextrose) infusion. The primary outcome was the proportion of patients progressing to a higher stage (injury or failure). Secondary outcomes were (i) need for renal replacement therapy, (ii) the effect on neutrophil gelatinase-associated lipocalin (urine and blood), (iii) fluid balance, (iv) adverse effects, (v) time to achieve renal recovery, (vi) duration of hospital stay and mechanical ventilation, and (vii) all-cause 28-d mortality. The trial was stopped for futility, and data were analyzed on an intention-to-treat basis (furosemide-group: n = 38; placebo-group: n = 37). No significant difference was noted in the progression of AKI to a higher stage between furosemide and placebo groups (10.5% vs. 21.6%; relative risk = 0.49, 95% CI 0.16 to 1.48) (p = 0.22). There were no differences in the secondary outcomes between the study groups. All-cause 28-d mortality was similar between the groups (10.5% vs. 10.8%). No trial-related severe adverse events occurred. Furosemide infusion in early-onset AKI did not reduce the progression to a higher stage of AKI. A future trial with large sample size is warranted.
登录
查看更多内容
影响因子：
19.6
作者：
KRAMER, HJ;SCHUURMANN, J;DUSING, R
通讯作者：
DUSING, R
影响因子：
19.6
作者：
Akcan-Arikan, A.;Zappitelli, M.;Goldstein, S. L.
通讯作者：
Goldstein, S. L.
影响因子：
3
作者：
Aravindan, Natarajan;Aravindan, Sheeja;Shaw, Andrew D.
通讯作者：
Shaw, Andrew D.
影响因子：
3.4
作者：
Mahesh, Balakrishnan;Yim, Boyd;Pigott, David
通讯作者：
Pigott, David
影响因子：
6.7
作者：
NARANJO, CA;BUSTO, U;GREENBLATT, DJ
通讯作者：
GREENBLATT, DJ