Development and Standardization of a Furosemide Stress Test to Predict the Severity of Acute Kidney Injury

• Published in: Critical care (London, England) Vol. 17; no. 5; p. R207
• Main Authors: Chawla, Lakhmir S, Davison, Danielle L, Brasha-Mitchell, Ermira, Koyner, Jay L, Arthur, John M, Shaw, Andrew D, Tumlin, James A, Trevino, Sharon A, Kimmel, Paul L, Seneff, Michael G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.09.2013; BioMed Central
• Subjects: Acute Kidney Injury - diagnosis; Acute Kidney Injury - urine; Acute renal failure; Aged; Cohort Studies; Diagnosis; Diuretics; Exercise Test - standards; Exercise Test - trends; Exercise tests; Female; Furosemide; Health aspects; Humans; Male; Middle Aged; Pilot Projects; Predictive Value of Tests; Prognosis; Prospective Studies; Retrospective Studies; Severity of Illness Index
• DOI: 10.1186/cc13015
• ISSN: 1364-8535; 1466-609X

In the setting of early acute kidney injury (AKI), no test has been shown to definitively predict the progression to more severe stages. 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. 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%. 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.