Furosemide

McMahon BA, et al. summarized the pharmacology and evolving clinical utility of the furosemide stress test (FST) in the management of acute kidney injury (AKI). Loop diuretics, including furosemide, exert their effects through unique renal pharmacology that is significantly altered in AKI. The FST—which involves administering a standardized furosemide dose and measuring urine output over the subsequent hours—has emerged as a valuable functional assessment tool. Evidence demonstrates that the FST effectively identifies patients with AKI who are at higher risk for disease progression and need for renal replacement therapy, outperforming static biomarkers. Additionally, the test shows promise in predicting successful discontinuation of continuous renal replacement therapy in established AKI.

Fig. 1 Schematic diagram showing the 12 transmembrane domain Na-K-2Cl (NKCC) transporter in the thick ascending limb of the loop of Henle. (McMahon BA, Chawla LS, 2021)

Mentz RJ, et al. compared torsemide versus furosemide in 2,859 patients discharged after hospitalization for heart failure, regardless of ejection fraction. Over a median follow-up of 17.4 months, all-cause mortality occurred in 26.1% of torsemide-treated patients and 26.2% of furosemide-treated patients (hazard ratio, 1.02; 95% CI, 0.89–1.18). Secondary outcomes, including all-cause mortality or hospitalization and total hospitalizations, also showed no significant differences between groups, with consistent findings across subgroups, including categories of ejection fraction.

Fig. 2 Participant flow in the TRANSFORM-HF randomized clinical trial. (Mentz RJ, et al, 2023)