Abstract: TH-OR099

The Effect of Early Initiation of Renal Replacement Therapy Guided by Furosemide Stress Test on Clinical Outcomes: A Multicenter Randomized Controlled Trial (FST Trial)

Session Information

  • Predicting AKI
    November 02, 2017 | Location: Room 282, Morial Convention Center
    Abstract Time: 04:42 PM - 04:54 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Lumlertgul, Nuttha, Chulalongkorn University, Bangkok, Thailand
  • Srisawat, Nattachai, Chulalongkorn University, Bangkok, Thailand
  • Peerapornratana, Sadudee, Chulalongkorn University, Bangkok, Thailand
  • Surasit, Karjbundid -, Nakornping hospital, Chiangmai, Thailand
  • Trakarnvanich, Thananda, Vajira Hospital, Bangkok, Thailand
  • Pongsittisak, Wanjak, Vajira Hospital, Bangkok, Thailand
  • Tankee, Pleumjit, Vachira Phuket Hospital, Phuket, Thailand
  • Tungsanga, Kriang, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
Background

Recently, furosemide stress test (FST) has been introduced as a novel acute kidney injury(AKI) test. Furosemide-nonresponsive AKI patients have poor outcomes. There are unavailable data whether early initiation of renal replacement therapy (RRT) in furosemide non-responsive AKI patients could provide better outcomes than standard RRT. This FST trial (NCT02730117) was conducted to determine whether early initiation of RRT in furosemide-nonresponsive patients could improve 28-day mortality.

Methods

AKI patients were recruited from 5 tertiary care hospitals. FST was performed by giving intravenous furosemide (1 mg/kg in furosemide-naïve or 1.5 mg/kg in previous furosemide use). Furosemide non-responsive patients (urine output less than 200 mL in 2 hours) were randomized into early or standard RRT group. With the early strategy, RRT was initiated within 12 hours after randomization. With the standard strategy, RRT was started when standard criteria were met. We also collected blood samples for testing plasma NGAL, NT-proBNP and angiopoietin-2 on day 0, 3, and 7.

Results

Among 87 furosemide-nonresponsive patients, 97.7% in the early RRT group and 70.5% in the standard RRT group received RRT. The 28-day mortality in the early RRT and the standard RRT were comparable (65.1 VS 56.8%, P=0.33). There was no difference in the dialysis dependence rate (35.3 VS 45%, P=0.55). Interestingly, urine output on day 7 in the early RRT group was lower than the standard RRT group (498.5 VS 1,560 mL, P=0.035). There was a trend of more hemodynamic instability related to RRT in the early RRT group than the standard group (32.6 VS 15.9%, P = 0.07). Of interest, time to renal recovery occurred significantly earlier in the standard than the early RRT group (2 VS 7 days; P=0.018). There were no differences in plasma NGAL, NT-proBNP, and angiopoietin-2 levels between 2 groups.

Conclusion

This was the first study to test the role of FST in guiding RRT initiation. Early RRT in furosemide-nonresponsive patients is not recommended since it could not improve 28-day mortality and might prolong time to renal recovery.

Funding

  • Government Support - Non-U.S.