• Jean-Maxime Côté, Josée Bouchard, Patrick T Murray, and William Beaubien-Souligny.
• Division of Nephrology, Centre hospitalier de l'Université de Montréal, Montréal, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada; Clinical Research Centre, University College Dublin, Ireland. Electronic address: jean-maxime.cote@umontreal.ca.
• J Crit Care. 2021 Oct 1; 65: 282-291.

PurposeTo investigate various diuretic strategies to alleviate loop-diuretics resistance in critically ill patients.Materials And MethodICU adults requiring more than 1 mg/kg/day of furosemide, from the MIMIC-III database. Four diuretic strategies were investigated: incremental dose of loop diuretics, continuous infusion, combinations with a second class of diuretics and administration of intravenous albumin. A generalized estimating equation was used to investigate the associations between these strategies and endpoints. The primary outcome was the 24-h urine output and secondary endpoints included fluid balance, weight change, electrolyte and acid-base abnormalities, kidney replacement therapy initiation, and mortality.ResultsA total of 7645 ICU stays from 6358 patients were included. After adjustment, the use of continuous loop-diuretic infusion was associated with a higher 24-h urine output (β: 732, 95% CI:669-795, p < 0.001), lower 24-h fluid balance (p < 0.001) and greater weight loss at 48-h (p < 0.001). Thiazide- and carbonic anhydrase inhibitor combinations were both associated with higher urine output (p < 0.001) and weight loss at 48-h (p < 0.01), while intravenous albumin was associated with fluid gain (p < 0.001). Risks of electrolyte and metabolic disturbances varied across diuretic strategies.ConclusionsContinuous loop-diuretic infusion and thiazide- or acetazolamide-loop diuretic combinations increased urine output significantly, leading to a negative fluid balance and weight loss.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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