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. 2024 Dec;28(12):1107-1111.
doi: 10.5005/jp-journals-10071-24862. Epub 2024 Nov 30.

Role of Spot Urine Sodium in Furosemide Stress Test in Volume-overloaded Critically Ill Patients with Acute Kidney Injury

P Suhas  1 , Rahul K Anand  2 , Dalim K Baidya  3 , Maya Dehran  2
Affiliations

Role of Spot Urine Sodium in Furosemide Stress Test in Volume-overloaded Critically Ill Patients with Acute Kidney Injury

P Suhas et al. Indian J Crit Care Med. 2024 Dec.

Abstract

Introduction and aims: Urine output (UO) in response to furosemide stress test (FST) can predict the progression of acute kidney injury (AKI). This study aimed to assess if changes in UO, urine spot sodium (USS), urine spot sodium creatinine ratio (USSCR) and changes in these parameters over 6 hours could differentiate between progressive and non-progressive AKI.

Materials and methods: Fifty critically ill adults with AKI in acute kidney injury network (AKIN) stages I and II with volume overload were included in this prospective study. The FST was performed with 1 mg/kg intravenous bolus. Hourly UO, USS, USSCR, maximum USS difference (USSDMAX), and maximum USSCR difference (USSCRDMAX) were documented. Any progression of AKI was noted till day 3.

Results: A total of 50 patients were recruited and n = 10 had progressive AKI (PAKI) and n = 40 had non-progressive AKI (NPAKI). Urine output at 1 and 2 h were significantly less in PAKI group. USS0, USS2, USS6, and USSDMAX were comparable between the groups. USSCR0 and USSCR6 were comparable between the groups whereas USSCR2 and USSCRDMAX were significantly less in PAKI group. USSDMAX did not correlate with UO1 (correlation coefficient 0.2, p = 0.16). However, USSCRDMAX showed a poor but significant correlation with UO1 (correlation coefficient 0.3, p = 0.03).

Conclusion: To conclude, hourly UO in the first two hours and maximum change in USSCR within 6 hours following the FST may have an important role in early differentiation of progressive AKI in critically ill patients.

How to cite this article: Suhas P, Anand RK, Baidya DK, Dehran M. Role of Spot Urine Sodium in Furosemide Stress Test in Volume-overloaded Critically Ill Patients with Acute Kidney Injury. Indian J Crit Care Med 2024;28(12):1107-1111.

Keywords: AKI progression; Acute kidney injury; Furosemide stress test; Urine spot sodium; Urine spot sodium creatinine ratio.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig. 1
Fig. 1
Graph showing the urine spot sodium (mmol/L) (USS), mean urine spot sodium creatinine ratio (USSCR) of the patients just before furosemide stress test (FST) 2 hours after FST and 6 hours after FST. It shows the trend of hourly urine output in mL (UO) 6-hour average before FST, at 2 hours after FST and 4–8-hour average post-FST. PAKI, Progressive AKI and NPAKI, Non-progressive AKI
Fig. 2
Fig. 2
Scatter plot representing correlation between maximum changes in urine spot sodium (USSD MAX in mmol/L) and urine output at first hour (UO1 in mL) in response to furosemide stress test (FST)
Fig. 3
Fig. 3
Scatter plot representing correlation between maximum changes in urine spot sodium creatinine ratio (USSCRD MAX) and urine output at first hour (UO1) in response to furosemide stress test (FST)
Fig. 4
Fig. 4
Scatter plot representing correlation between maximum urine spot sodium creatinine ratio (USSCRD MAX) and urine output (mL) of first hour (UO1) in response to furosemide stress test (FST), excluding values above 1,000
See this image and copyright information in PMC

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