Lasix and Renal Failure

[missjustice]

So I had an ESRD patient who was getting dialysis three times a week, and was oliguric at baseline (he said he peed small amounts maybe two or three times a month). He also had hypertension, and he was getting a bunch of meds to control it, one being Lasix.

I know that sometimes Lasix is used in oliguric patients to try to get better urine output, but he was apparently getting it solely to control his BP.

My question is, how effective would this be? If he was only putting out a minimal amount of urine even with the Lasix, would it really be helpful for lowering his blood pressure?

[KBICU]

Good question! just keep it simple...if their kidneys are so poor their not making urine and their on dialysis dont anticipate it working too well since Lasix is a loop diuretic - works directly in the kidney tubules. Why is your patiend in end stage renal disease even getting Lasix (vs another BP med?) it is very nephrotoxic. Were his Bun and creatinine levels okay?

[AZMOMO2]

Nope it wouldn't because the purpose of a diuretic for control of BP would be to remove excess fluid via the kidneys. If the kidneys are not ABLE to remove the excess fluid then this medication will not have the desired effect and if only minimal urine is output then they are probably still retaining the extra fluid. An ACE or ARB is probably the only thing controlling BP... is the person on dialysis?

Because according to,

Nephron. 1975;14(5):333-8.

[h=1]Effects of large doses of furosemide in end-stage chronic renal failure.[/h]Vereerstraeten PJ, Dupuis F, Toussaint C.

[h=3]Abstract[/h]Administered orally at 500 mg/day to patients in end-stage chronic renal failure treated by hemodialysis, furosemide significantly decreases the weight gain between dialyses and increases sodium excretion rate. This therapy remains without effect on blood pressure, creatinine clearance and urinary excretion of potassium and nitrogen. Devoid of any side-effects, at least during short periods, the treatment may contribute to achieve better control of sodium and water balance.

[Esme12, ASN, BSN, RN]

Lasix for B/P control and dialysis.......I've heard it used for weight fluid control as stated above....B/P control .....not so much.

[traumaRUs, MSN, APRN]

Oversight by provider - should be dc'd. No reason whatsoever to Rx with lasix in ESRD pt who does not produce urine.

[AgentBeast, MSN, RN]

The only reason to give Lasix to an ESRD patient is to challenge the kidneys to see if there is any renal function left. Otherwise since Lasix works on the kidneys it isn't going to do diddly squat if there isn't any functional kidney for the Lasix to work on and should be DC'ed.

Typically you'll see renal patients on ACE inhibitors or ARBs to manage BP.

[missjustice]

Thanks for the answers everyone. His BUN and creat were okay-ish, but he'd been getting dialysis for nearly a year. Apparently he'd been taking Lasix at home, and the nurse thought that his primary probably just forgot to take him off it, but the team didn't want to DC it.