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

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

Full description

Saved in:

Bibliographic Details
Published in:	Journal of critical care Vol. 52; pp. 109 - 114
Main Authors:	Rewa, O.G., Bagshaw, S.M., Wang, X., Wald, R., Smith, O., Shapiro, J., McMahon, B., Liu, K.D., Trevino, S.A., Chawla, L.S., Koyner, J.L.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-08-2019 Elsevier Limited
Subjects:	Acute kidney injury Acute Kidney Injury - diagnosis Acute Kidney Injury - mortality Acute Kidney Injury - urine Aged Area Under Curve Critical Illness - mortality Disease Progression Diuretics Female Furosemide - pharmacology Furosemide stress test Hospitals Humans Intensive care Intensive care unit Intensive Care Units Kidneys Male Middle Aged Mortality Observational studies Patients Predictive Value of Tests Prospective Studies Sensitivity and Specificity Sodium Potassium Chloride Symporter Inhibitors Statistical analysis Urodynamics Young Adult Canada United States > US San Francisco California Acute kidney injury Intensive care unit Furosemide stress test
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	To validate the furosemide stress test (FST) for predicting the progression of acute kidney injury (AKI). 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. 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%. 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. •AKI is common in critically ill patients.•There is no previously validated test to predict progression of AKI.•The Furosemide Stress Test is able to predict worsening AKI.
ISSN:	0883-9441 1557-8615
DOI:	10.1016/j.jcrc.2019.04.011