Abstract: SA-PO016

Furosemide Stress Test and Renal Angina Index for the Prediction of AKI

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Claure-Del Granado, Rolando, Universidad Mayor de San Simon, School of Medicine, Cochabamba, Bolivia, Plurinational State of
  • Serrano-Pinto, Yamile, Hospital Obrero #2 - C.N.S., Cochabamba, Bolivia, Plurinational State of
  • Torrico-Guillen, Daniela, Hospital Obrero #2 - C.N.S., Cochabamba, Bolivia, Plurinational State of
Background

In recent years several approaches for identifying patients at risk of acute kidney injury (AKI) were used; among them two have been of increasing interest: the Furosemide Stress Test (FST) and the Renal Angina Index (RAI). These two different approaches aim to identify patients at risk for subsequent AKI, and also have been used for the prediction of AKI severity. We assessed the performance of these two different approaches to identify patients at risk of AKI in an ongoing cohort of adult critically ill patients.

Methods

We analyzed data from 58 hospitalized patients admitted to a Medical ICU. We measured serum creatinine (sCr) every 24 hours for 7 consecutive days following ICU admission, and urinary volume was assessed hourly each 24 hours. At admission (day 0), RAI (1-40) was calculated using the following formula: Risk level (presence of sepsis = 1 point, presence of diabetes = 3 points, and vasopressors and use of invasive mechanical ventilation = 5 points) x Injury level (changes in eGFR: no change = 1 point, 0-24.9% = 2 points, 25-50% = 4 points, ≥ 50% = 8 points); and we applied the FST at day 0 (as describe by Chawla et. al. in Crit Care 2013 Sep 20; 17(5): R207). We assessed the performance of the FST and the RAI to predict the subsequent development of AKI using KDIGO sCr and urinary volume criteria.

Results

Of the 58 patients included in this study, 5 (8.6%) patients met the primary end point of AKI (sCr KDIGO criteria) and 4 (6.8%) using urinary volume KDIGO criteria. The performance of Furosemide Stress Test and the Renal Angina Index are shown on figure 1.
Of note, we consider a cut-off point of <725 cc of urine at 2 hours for Furosemide Stress Test since none of the patients who developed AKI had <200 cc of urine at 2 hours as the original cut-off proposed value.

Conclusion

The Furosemide Stress Test and the Renal Angina Index have robust predictive capacity to identify critically ill patients at high risk of developing AKI before a rise in sCr occurs. These preliminary data of our ongoing study warrants future studies to validate these findings.

Figure 1. Performance of the Furosemide Stress Test and the Renal Angina Index