Prevention of acute renal failure: Role of vaso-active drugs, mannitol and diuretics

A. R J Girbes*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Evidence exists that acute renal failure (ARF) independently increases mortality risk in critically-ill patients. Therefore prevention of ARF seems of paramount importance. Preservation of renal blood flow and (sufficient) perfusion pressure favourably influences the prevention of renal function deterioration in the critically-ill septic patient. The first step to achieve this is infusion of fluids, either crystalloids or colloids, with the aim of optimal fluid resuscitation. Although "optimal fluid resuscitation" is poorly defined, in clinical practice it can be considered as the point where a certain preload is obtained, after which no further increase of cardiac output is observed with further fluid infusion. Vasoactive drugs can be added to this regimen in case of insufficient restoration of flow and especially perfusion pressure. The addition of norepinephrine can be of value if high doses of dopamine fail to restore perfusion pressure. No evidence exists that low-dose dopamine prevents renal failure and, therefore, dopamine should not be given for this indication. The use of diuretic agents can be harmful, as indicated by observational and cohort studies. Although mannitol flushes out intratubular casts and increases tubular flow, which is favorable in myoglobinuria or hemoglobinuria, so far no well designed clinical studies have demonstrated its efficacy in ARF. In conclusion, there is currently no convincing evidence for any benefit from diuretic agents and/or (low dose) dopamine in the prevention of ARF High quality intenisve care and avoidance of harm is, therefore, the current standard of the prevention of ARF.

Original languageEnglish
Pages (from-to)1049-1053
Number of pages5
JournalInternational Journal of Artificial Organs
Volume27
Issue number12
Publication statusPublished - 1 Dec 2004

Cite this