Development and standardization of a furosemide stress test to predict the severity of acute kidney injury.

Published online

Journal Article

INTRODUCTION: In the setting of early acute kidney injury (AKI), no test has been shown to definitively predict the progression to more severe stages. 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 AKIN Stage-III in 2 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 as part of Southern AKI Network. Cohort 2 was a prospective multicenter group of critically ill 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.

Full Text

Cited Authors

  • Chawla, LS; Davison, DL; Brasha-Mitchell, E; Koyner, JL; Arthur, JM; Shaw, AD; Tumlin, JA; Trevino, SA; Kimmel, PL; Seneff, MG

Published Date

  • September 20, 2013

Published In

Volume / Issue

  • 17 / 5

Start / End Page

  • R207 -

PubMed ID

  • 24053972

Pubmed Central ID

  • 24053972

Electronic International Standard Serial Number (EISSN)

  • 1466-609X

Digital Object Identifier (DOI)

  • 10.1186/cc13015

Language

  • eng

Conference Location

  • England