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. 2025 Mar;57(3):999-1008.
doi: 10.1007/s11255-024-04271-7. Epub 2024 Nov 15.

Association between the use of loop diuretics and prognosis in critically ill patients with acute kidney injury: a retrospective propensity score-matched cohort study

Hua Xiao  1   2   3 , Kai Liu  4 , Hong-Hao Meng  5 , Yun-Peng Peng  6 , Guo-Bao Hong  7 , Xin-Zhou Zhang  8   9
Affiliations

Association between the use of loop diuretics and prognosis in critically ill patients with acute kidney injury: a retrospective propensity score-matched cohort study

Hua Xiao et al. Int Urol Nephrol. 2025 Mar.

Abstract

Background: The role of loop diuretics in patients with acute kidney injury (AKI) is controversial. This study examined the association between the use of loop diuretics and prognosis in critically ill patients with AKI.

Methods: This study used data from the medical information mart for the intensive care IV database. Adult critically ill patients with AKI were included in the analysis. Patients were partitioned into two groups based on their use of loop diuretics in the ICU, and potentially confounding variables between the two groups were balanced using propensity score matching (PSM). We used time-dependent Cox proportional hazards regression, logistic regression, and Hodges-Lehman estimator to assess the impact of loop diuretics on all-cause mortality, renal replacement therapy (RRT) use, and the length of hospital stay, respectively.

Results: This study included a cohort of 19,671 patients. After PSM, both groups consisted of 6200 patients. The use of loop diuretics was associated with a lower risk of in-hospital mortality (HR, 0.672; 95% CI 0.597-0.757; P < 0.001), lower in-ICU mortality (HR, 0.375; 95% CI 0.315-0.446; P < 0.001), and lower odds of in-hospital RRT (OR, 0.472; 95% CI 0.400-0.555; P < 0.001). A sensitivity analysis using the original cohort (HR, 0.624; 95% CI 0.561-0.693; P < 0.001) and weighted cohort (HR, 0.654; 95% CI 0.582-0.736; P < 0.001) also demonstrated lower in-hospital all-cause mortality.

Conclusions: The use of loop diuretics is associated with a substantial reduction in mortality among critically ill patients with AKI.

Keywords: Acute kidney injury; Diuretic; Fluid overload; Intensive care; Survival analysis.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethics approval and consent to participate: The study is based on the latest MIMIC-IV version 2.0 database. Because the analysis used publicly available deidentified data, the institutional review board review at Beth Israel Deaconess Medical Center was waived and informed consent procedures were not needed.

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