Low-dose loop diuretics improve survival and renal function in cancer patients with early-stage sepsis-associated acute kidney injury.

Sepsis often causes sepsis-associated acute kidney injury (S-AKI) and is a leading cause of death in critically ill cancer patients. This study aims to assess the prognostic value of loop diuretic use in cancer patients with S-AKI. A retrospective cohort of 117 cancer patients with S-AKI admitted to the ICU between 2009 and 2023 was analyzed. Among them, 90 patients treated with loop diuretics were categorized into four groups according to AKI stage and furosemide dose: early-stage with low-dose, early-stage with high-dose, late-stage with low-dose, and late-stage with high-dose. Additionally, 27 early-stage patients who did not receive diuretics were included as a comparator group. The primary outcome was 28-day mortality. Patients receiving low-dose furosemide at early-stage AKI had significantly lower 28-day mortality (22.7%, p = 0.049), lower CRRT initiation (18.2 vs. 44.0, 76.2, and 81.8%, p = 0.001), and higher shock reversal (83.3%, p = 0.042), with no difference in ICU stay (p = 0.276). In early-stage patients treated with low-dose furosemide who did not require CRRT, serum creatinine (p = 0.030) and lactate (p = 0.002) declined significantly, while urine output markedly increased (p < 0.0001) during the first three ICU days. Compared with early-stage patients who did not receive diuretics, the low-dose group also showed lower 28-day mortality (22.7%, p = 0.039). These findings suggest that low-dose loop diuretics administered in the early stage of S-AKI (stages 1 and 2) may improve survival and renal function in cancer patients, warranting confirmation in large-scale prospective randomized controlled trials.