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Rethinking diuretic use in acute kidney injury: effective prevention or false hope?

Hiroyuki Yamada1,2, Maki Murata3, Hiroyuki Hashimoto4

  • 1Department of Primary Care and Emergency, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-Ku, Kyoto, 6068507, Japan. hyamada@kuhp.kyoto-u.ac.jp.

Journal of Intensive Care
|June 16, 2025
PubMed

Insights

Prophylactic diuretics effectively prevent acute kidney injury (AKI) in high-risk individuals but do not treat established AKI. Further research is needed before changing clinical practice guidelines.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Current guidelines often discourage prophylactic diuretic use for acute kidney injury (AKI).
  • A large meta-analysis of randomized controlled trials (RCTs) investigated the efficacy of prophylactic diuretics.
  • This analysis included the largest sample size to date with pre-specified methods.

Discussion:

  • Findings indicate prophylactic diuretics significantly reduce AKI incidence in high-risk patients.
  • No significant benefit was observed in treating patients with established AKI.
  • Results challenge existing clinical practice guidelines regarding diuretic use.

Key Insights:

  • Prophylactic diuretics show promise in AKI prevention for at-risk populations.
  • Diuretics are ineffective for treating existing AKI.
  • Evidence suggests a potential shift in preventative strategies for AKI.

Outlook:

  • Heterogeneity and risk of bias in trials necessitate cautious interpretation.
  • Further research is recommended to confirm these findings before altering clinical practice.
  • Potential for revised guidelines on AKI prevention strategies.

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