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Use of furosemide in preterm neonates with acute kidney injury is associated with increased mortality: results from the TINKER registry

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Abstract

Background

Diuretics are commonly used in neonatal AKI with the rationale to decrease positive fluid balance in critically sick neonates. The patterns of furosemide use vary among hospitals, which necessitates the need for a well-designed study.

Methods

The TINKER (The Indian Iconic Neonatal Kidney Educational Registry) study provides a database, spanning 14 centres across India since August 2018. Admitted neonates (≤ 28 days) receiving intravenous fluids for at least 48 h were included. Neonatal KDIGO criteria were used for the AKI diagnosis. Detailed clinical and laboratory parameters were collected, including the indications of furosemide use, detailed dosing, and the duration of furosemide use (in days).

Results

A total of 600 neonates with AKI were included. Furosemide was used in 8.8% of the neonates (53/600). Common indications of furosemide use were significant cardiac disease, fluid overload, oliguria, BPD, RDS, hypertension, and hyperkalemia. The odds of mortality was higher in neonates < 37 weeks gestational age with AKI who received furosemide compared to those who did not receive furosemide 3.78 [(1.60–8.94); p = 0.003; univariate analysis] and [3.30 (1.11–9.82); p = 0.03]; multivariate logistic regression].

Conclusions

In preterm neonates with AKI, mortality was independently associated with furosemide treatment. The furosemide usage rates were higher in neonates with associated co-morbidities, i.e. significant cardiac diseases or surgical interventions. Sicker babies needed more resuscitation at birth, and died early, and hence needed shorter furosemide courses. Thus, survival probability was higher in neonates treated with long furosemide courses vs. short courses.

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Funding

This study was a result of support received from ISN Clinical Research Grant 2017.

Author information

Authors and Affiliations

  1. Pediatric Nephrology, Akron Children’s Hospital, One Perkins Square, Akron, OH, 44308-1062, USA

    Rupesh Raina & Abhishek Tibrewal

  2. Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India, 122001

    Sidharth Kumar Sethi & Kritika Soni

  3. Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India, 122001

    Gopal Agrawal

  4. Neonatology, Motherhood Hospitals, 122011, Gurgaon, India

    Sanjay Wazir

  5. Neonatology, Deep Hospital, Ludhiana, Punjab, India

    Naveen Bajaj

  6. Neonatology, Madhukar Rainbow Children’s Hospital, New Delhi, India

    Naveen Parkash Gupta

  7. Maulana Azad Medical College, New Delhi, India

    Ananya Vadhera

  8. Government Medical College, Miraj, Maharashtra, India

    Shishir Mirgunde

  9. Aster Mims Hospital, Kottakkal, Kerala, India

    Binesh Balachandran

  10. Department of Neonatology, AIIMS, Bhubaneswar, India

    Jagdish Sahoo

  11. Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Uttar Pradesh, Aligarh, India

    Kamran Afzal

  12. MLM Medical College, Prayagraj, Uttar Pradesh, India

    Anubha Shrivastava

  13. ESI Post Graduate Institute of Medical Science Research, Basaidarapur, New Delhi, India

    Jyoti Bagla

  14. JSS Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India

    Sushma Krishnegowda

  15. KIMS Hospital, Kurnool, Andhra Pradesh, India

    Ananth Konapur

  16. Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Khalid Alhasan

  17. Solid Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Khalid Alhasan

  18. Paediatric Renal and Solid Organ Transplant, Red Cross War Memorial Children’s Hospital, Rondebosch, Cape Town, South Africa

    Mignon McCulloch

  19. Children’s Hospital of Richmond, Richmond, VA, USA

    Timothy Bunchman

Authors
  1. Rupesh Raina
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  2. Sidharth Kumar Sethi
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  3. Gopal Agrawal
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  6. Naveen Parkash Gupta
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  7. Abhishek Tibrewal
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  8. Ananya Vadhera
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  9. Shishir Mirgunde
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  10. Binesh Balachandran
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  11. Jagdish Sahoo
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  12. Kamran Afzal
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  14. Jyoti Bagla
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  15. Sushma Krishnegowda
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  16. Ananth Konapur
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  17. Kritika Soni
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  18. Khalid Alhasan
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  19. Mignon McCulloch
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  20. Timothy Bunchman
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Contributions

All authors made substantial contributions to the conception and design, acquisition of data, analysis and interpretation of data, and drafting the article or revising it critically for important intellectual content. All authors gave final approval of the version to be published.

Corresponding author

Correspondence to Rupesh Raina.

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Ethics committee approval

IEC/C9791/0706/18005

Consent statement

Consents taken from the parents for inclusion in the study.

Competing interests

The authors declare no competing interests.

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None.

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Both Dr. Rupesh Raina and Dr. Sidharth Kumar Sethi contributed equally and shall be first authors.

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Raina, R., Sethi, S.K., Agrawal, G. et al. Use of furosemide in preterm neonates with acute kidney injury is associated with increased mortality: results from the TINKER registry. Pediatr Nephrol 39, 857–865 (2024). https://doi.org/10.1007/s00467-023-06086-7

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  • DOI: https://doi.org/10.1007/s00467-023-06086-7

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