Development and standardization of a furosemide stress test to predict the severity of acute kidney injury.
Crit Care. 2013 Sep 20;17(5):R207
Authors: Chawla LS, Davison DL, Brasha-Mitchell E, Koyner JL, Arthur JM, Tumlin JA, Shaw AD, Trevino S, Kimmel PL, Seneff MG
Abstract
BACKGROUND: In the setting of early acute kidney injury (AKI), no test has been shown to definitively predict the progression to more severe stages. Materials and Methods: We investigated the ability of a furosemide stress test (FST) (one-time dose of 1.0 or 1.5 mg/kg depending on prior furosemide-exposure) to predict the development of Acute Kidney Injury Network (AKIN) Stage-III in two cohorts of critically ill subjects with early AKI. Cohort 1 was a retrospective cohort who received a FST in the setting of AKI in critically ill patients part of Southern AKI Network. Cohort 2 was a prospective multicenter group of critical patients who received their FST in the setting of early AKI.
RESULTS: We studied 77 subjects; 23 from cohort 1 and 54 from cohort 2; 25 (32.4%) met the primary endpoint of progression to AKIN-III. Subjects with progressive AKI had significantly lower urine output following FST in each of the first 6 hours (p<0.001). The area under the receiver operator characteristic curves for the total urine output over the first 2 hours following FST to predict progression to AKIN-III was 0.87 (p = 0.001). The ideal-cutoff for predicting AKI progression during the first 2 hours following FST was a urine volume of less than 200mls(100ml/hr) with a sensitivity of 87.1% and specificity 84.1%.
CONCLUSIONS: The FST in subjects with early AKI serves as a novel assessment of tubular function with robust predictive capacity to identify those patients with severe and progressive AKI. Future studies to validate these findings are warranted. Clinical trial numbers: NCT00673244, NCT01275729.
PMID: 24053972 [PubMed - as supplied by publisher]