- Loop diuretics are the most commonly used diuretics in CKD.
- In CKD Stages 4-5, furosemide should be started at a dose of 40 to 80 mg once daily with weekly titration upwards by 25% to 50% dependent upon the response and ECF volume.
- Once an effective dose has been established, the frequency with which it needs to be administered can be determined by specific clinical needs.
- In the absence of specific conditions causing increased sodium reabsorption (nephrotic syndrome, heart failure, or cirrhosis), a brisk diuretic response occurs in response to a loop diuretic with only nominal dose titration.
- In patients with specific conditions causing increased sodium reabsorption, the response to a loop diuretic is attenuated in relationship to the severity of the underlying disease, and substantially higher doses of furosemide may be necessary to achieve a diuresis.
- Furosemide is actively secreted by the proximal tubules into the urine before reaching its site of action at the ascending limb of loop of Henle.
- It is the urinary concentrations of furosemide that determine its diuretic effect.
- The severity of acute kidney injury has a significant effect on the diuretic response to furosemide; a good 'urinary response' may be considered as a 'proxy' for having some residual renal function.
According to Lexicomp:
Under continuous IV infusion, when CrCl is less than 25ml/min, the upper end of the
initial infusion dosage range should be considered.
If urine output is less than 1ml/kg/hr, double as necessary
to a maximum of 80-160mg/hour.
References:
Lexicomp
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