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Observational Study
. 2019 Aug:52:109-114.
doi: 10.1016/j.jcrc.2019.04.011. Epub 2019 Apr 9.

The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study

O G Rewa  1 , S M Bagshaw  2 , X Wang  3 , R Wald  4 , O Smith  5 , J Shapiro  4 , B McMahon  6 , K D Liu  7 , S A Trevino  8 , L S Chawla  9 , J L Koyner  8
Affiliations
Observational Study

The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study

O G Rewa et al. J Crit Care. 2019 Aug.

Abstract

Purpose: To validate the furosemide stress test (FST) for predicting the progression of acute kidney injury (AKI).

Materials and methods: We performed a multicenter, prospective, observational study in patients with stage I or II AKI. The FST (1 mg/kg for loop diuretic naïve patients and 1.5 mg/kg in patients previously exposed to loop diuretics) was administered. Subsequent urinary flow rate (UFR) recorded and predictive ability of urinary output was measured by the area under the curve receiver operatic characteristics (AuROC). Primary outcome was progression to Stage III AKI. Secondary outcomes included in-hospital mortality and adverse events.

Results: We studied 92 critically ill patients. 23 patients progressed to stage III AKI and had significantly lower UFR (p < 0.0001). The UFR during the first 2 h was most predictive of progression to stage III AKI (AuROC = 0.87), with an ideal cut-off of less than 200mls, with a sensitivity of 73.9% and specificity of 90.0%.

Conclusion: In ICU patients without severe CKD with mild AKI, a UFR of less than 200mls in the first 2 h after an FST is predictive of progression to stage III AKI. Future studies should focus on incorporating a FST as part of a clinical decision tool for further management of critically ill patients with AKI.

Keywords: Acute kidney injury; Furosemide stress test; Intensive care unit.

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Figures

Figure 1.
Figure 1.. Urinary output in response to FST-
For each hourly interval, there was a significantly higher urine output in patients who did not progress to AKIN stage III AKI in response to the furosemide stress test. This was most pronounced in hour 2 but was maintained for 6 hours following the furosemide stress test. AKIN – acute kidney injury network.
See this image and copyright information in PMC

References

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