Kazory, Amir

Purpose of review The diuretic agents are commonly used in ICUs for various purposes. Despite the widespread utilization of diuretics, there remains substantial ambiguity regarding their indications, ICU-related changes in their pharmacodynamics and pharmacokinetics, dosing, form, and timing of administration, the differences in their utilities based on each organ failure, and their monitoring and safety issues. Recent findings In the recent past, there have been several clinical trials and large registries or systematic reviews with a focus on the use of diuretic agents in ICUs. Summary In this review article, we outline the essential changes in drug behavior during critical illnesses and organ failures, describe the indications of their use in ICUs (management of fluid overload, electrolyte imbalances, or diagnostic or prognostic tests), assess the impact of different organ failures on the utility and effectiveness of diuretics, review major recent clinical trials related to diuretic comparison, use of multiple classes of diuretics, and monitoring and safety of their use. We also provide some information regarding the safety and adverse effects of diuretic use in the ICU and outline the importance of individualizing their use during critical illnesses.

ABSTRACT Point-of-care ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and ‘lack of’ standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.