ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR119

The Furosemide Stress Test Predicts Severe AKI: A Multicenter Validation

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
  • Rewa, Oleksa G., University of Alberta, Edmonton, Alberta, Canada
  • McMahon, Blaithin A., Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Chawla, Lakhmir S., University of California, San Diego, San Diego, California, United States
  • Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
  • Liu, Kathleen D., University of California at San Francisco School of Medicine, San Francisco, California, United States
  • Bagshaw, Sean M., University of Alberta, Edmonton, Alberta, Canada

Group or Team Name

  • Furosemide Stress Test (FST) Investigators
Background

The Furosemide Stress Test (FST) has been previously shown to predict which patients with Stage 1 or 2 AKI will progress to Stage 3 AKI.

Methods

We conducted a prospective multicenter validation of the FST at 5 centers across North America. Euvolemic or hypervolemic patients with Stage 1 & 2 AKI were given 1 or 1.5 mg/kg of intravenous furosemide, depending on prior exposure. Hourly urine output (UOP) was measured for 6 hours (hrs) to validate the previously published cutoff of 200 ml of urine in the first 2 hrs as well as to explore other cutoffs. We assessed the ability of the FST to predict the development of KDIGO Stage 3 AKI (primary endpoint – 200% increase in serum creatinine or receipt of renal replacement therapy (RRT)) and just the receipt of RRT, as well as occurrence of adverse events.

Results

We prospectively enrolled 92 patients with Stage 1 or 2 AKI who received a mean(SE) dose of 108(3.7) mg of furosemide. Twenty-three (25%) patients developed subsequent Stage 3 AKI, with 10 (11%) receiving RRT. There was no difference in baseline serum creatinine or eGFR, dose of furosemide, cardiovascular SOFA score or APACHE II score between those with and without Stage 3 AKI. Patients who progressed had significantly lower UOP in the 6hrs before the FST (median[IQR]) (241[93-357] compared to 336[199-578] p=0.024). The total UOP for the first 2hrs post-FST provided an AUC(SE) of 0.85(0.05) for progression to stage 3 (p<0.001) and 0.73(0.10) for RRT (p<0.05) (Table) UOP of less than 200ccs in the first 2hrs was 89.8% specific for AKI progression. In terms of adverse events, hypotension developed in 9(10%) patients post FST and 5(6%) patients developed hypokalemia and 5(6%) patients developed hypophosphatemia.

Conclusion

In this multicenter validation, the 2 hour total UOP following FST predicted the progression to Stage 3 AKI and the need for RRT. UOP of less than 200 cc in the first 2hrs post-FST is a highly specific for progression to Stage 3 AKI, while less than 400 cc is highly sensitive for AKI progression.

Sensitivity Analysis for 2 hour UOP following FST to predict Stage 3 AKI
2 hr UOP Cutoff (ccs total)SensitivitySpecificity
<10043.4%94.2%
<20073.9%89.9%
<30082.6%84.1%
<40087.0%62.3%

Funding

  • Commercial Support