Key result
Continuous bumetanide infusion yielded a mean urine output of 1.88 mL/kg/hour (95% CI 1.72-2.05) and an acute kidney injury incidence of 24.7% (95% CI 8.2-54.6).
Why the study?
Continuous bumetanide infusion is commonly used for acute heart failure and volume overload, but there is not enough supporting evidence evaluating its use.
What are the treatment outcomes (urine output and AKI incidence) of continuous bumetanide infusion in adult patients with heart failure, AKI, or volume overload?
Meta-Analysis (n=94)
What are the treatment outcomes (urine output and AKI incidence) of continuous bumetanide infusion in adult patients with heart failure, AKI, or volume overload?
Continuous bumetanide infusion effectively increases urine output in patients with acute heart failure or volume overload, but is associated with a significant risk of AKI that correlates with higher doses.
Supports cautious use of continuous bumetanide for diuresis with AKI monitoring; leaves comparative efficacy and dosing optimization open.
The clinical use of continuous bumetanide infusion for acute heart failure and volume overload is common. However, there is not enough supporting evidence for the use of continuous bumetanide infusion. Thus, we conducted this systematic review and meta-analysis aiming to describe the treatment outcomes of continuous bumetanide infusion. We searched Ovid MEDLINE, EMBASE and the Cochrane Library for eligible publications. Inclusion criteria were patients age ≥18 years with bumetanide infusion for heart failure, acute kidney injury (AKI) or volume overload. From 1564 citations, three studies (n = 94 patients) were included in the systematic review and meta-analysis. The mean dose of bumetanide was 1.08 ± 0.43 mg/hour with a mean treatment duration of 45.09 ± 10.12 hours. Mean urine output in response to continuous bumetanide infusion was 1.88 mL/kg/hour (95% confidence interval [CI], 1.72-2.05). The incidence of AKI with continuous bumetanide infusion was 24.7% (95% CI, 8.2-54.6). By using Pearson's correlation coefficient, increasing doses of bumetanide were correlated with increased urine output (P = .026) and increased incidence of AKI (P < .01). There was no correlation between increasing urine output and the incidence of AKI (P = .739). In conclusion, with available evidence, continuous bumetanide infusion may be used in the treatment of acute heart failure or volume overload with close monitoring for new-onset or worsening AKI.
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Hansrivijit et al. (2020) conducted a meta-analysis in acute heart failure, acute kidney injury, or volume overload (n=94). continuous bumetanide infusion was evaluated on mean urine output (mL/kg/hour) (95% CI 1.72-2.05). Continuous bumetanide infusion yielded a mean urine output of 1.88 mL/kg/hour (95% CI 1.72-2.05) and an acute kidney injury incidence of 24.7% (95% CI 8.2-54.6).
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