Efficacy of Furosemide-Albumin Compared to Bumetanide in Critically Ill Patients

Introduction: Loop diuretics are commonly used to manage fluid overload in critically ill patients. However, diuretic resistance remains a significant challenge. This study aims to evaluate the effects of continuous bumetanide versus continuous albumin-furosemide infusions in critically ill patients.


Methods: This was a retrospective, single health-system cohort study from January 1, 2022, to January 1, 2024 of critically ill adult patients who received bumetanide or furosemide-albumin continuous infusions for at least 24 hours. Exclusion criteria included nephrotic syndrome, defined as a random urine protein-to-creatinine ratio greater than 3,000 mg/g or a past medical history of nephrotic syndrome, severe renal impairment, defined as a serum creatinine greater than 4 mg/dL, and end-stage renal disease. The primary endpoint was urine output at 24 hours after diuretic initiation. Secondary endpoints included total diuretic dose in intravenous furosemide equivalents, total albumin administered, and changes in serum creatinine and albumin at 24 hours following diuretic initiation. Continuous data are presented as medians with interquartile ranges.


Results: Among the 434 patients included, 173 received continuous bumetanide infusion and 261 received continuous furosemide-albumin infusion. Baseline characteristics revealed lower creatinine clearance, higher blood urea nitrogen, and higher serum albumin levels in the bumetanide group. There was no significant difference in urine output at 24 hours between the bumetanide and the furosemide-albumin groups (3578 mL [1818–4738] vs. 3617 mL [2035–4703]; p = 0.304). However, the bumetanide group required a significantly higher total diuretic dose in intravenous furosemide equivalents (481 mg [295–544] vs. 177 mg [109–236]; p < 0.001), but there was no significant difference in change in serum creatinine. The furosemide-albumin group received a significantly higher total albumin dose (10.9 g [0–12.5] vs. 43.7 g [27.5–58.9]; p < 0.001).


Conclusions: In critically ill patients requiring diuresis, continuous infusion of bumetanide resulted in a comparable urine output to continuous furosemide-albumin infusion. These findings suggest that bumetanide may be an effective alternative for fluid management in this patient population.