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(Journal Article) |
Critical care (London, England) 17 (5): R207 (2013)
Development and standardization of a furosemide stress test to predict the severity of acute kidney injury.
Lakhmir S Chawla
,
Danielle L Davison
,
Ermira Brasha-Mitchell
,
Jay L Koyner
,
John M Arthur
,
Andrew D Shaw
,
James A Tumlin
,
Sharon A Trevino
,
Paul L Kimmel
,
Michael G Seneff
ABSTRACT
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.