Study says diuretics may harm kidney patients

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http://www.charlotte.com/mld/observer/news/4622952.htmStudy says diuretics may harm kidney patientsScientists find higher death rate when usedROSIE MESTELLos Angeles TimesThe common practice of using diuretics to treat acute kidney failure may do more harm than good, according to a new California study.Patients whose kidneys go into sudden failure are often given diuretics -- drugs to help rid the body of accumulating fluid. But the study, reported in Wednesday's Journal of the American Medical Association, found that patients given these drugs had a 68 percent higher death rate than those who were not.The authors and several kidney experts stressed that the study cannot conclude for sure that the diuretics caused the increased death rate. For example, on average, the patients given diuretics were older and sicker to begin with, and while the authors tried to control for such factors, they may not have been able to do so perfectly.But the findings add to a body of research suggesting that diuretics often may do little good for such patients. It suggests that doctors must monitor people with acute kidney failure closely and make sure that they don't delay other treatments, such as dialysis, if the patients are not responding to diuretics.The study examined only patients with acute kidney failure, and has no bearing on patients with chronic kidney failure.The study was conducted by a team of researchers led by Dr. Ravindra Mehta, professor of medicine and director of the clinical nephrology and dialysis programs at the University of California, San Diego. Examining the records of 552 patients, the scientists found not only a higher death rate in patients given diuretics but also a higher rate of subsequent chronic kidney failure requiring dialysis. The death rate was especially high in patients who failed to quickly respond to the diuretics with an increased flow of urine."I think this should call for a reappraisal of our frequent use of diuretics in critically ill patients with acute kidney failure," Mehta said.Dr. Richard Lafayette, associate professor of medicine and clinical chief in the division of nephrology at Stanford University, said the evidence is still not strong enough to warrant a change in medical practice.