Furosemide Stress Test Guiding Initiation of Renal Replacement Therapy

Launched by CHULALONGKORN UNIVERSITY · Mar 31, 2016

Keywords

ClinConnect Summary

The objective is to determine if early initiation of renal replacement therapy guided by positive furosemide stress test has an impact on 7-day fluid balance in critically ill patients with acute kidney injury

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Age older than 18 years old and admission in an ICU
• • Acute kidney injury (defined by serum creatinine increase ≥ 0.3 mg/dL or urine output ≤ 0.5 mL/kg/hour according to KDIGO criteria)
• • Informed consent provided by the patient or person with decisional responsibility
• • Indwelling bladder catheter
• • Documented cause of acute kidney injury from acute tubular necrosis e.g. presence of granular or epithelial casts on urine sediment, FeNa more than 1%, Feurea more than 50%, urine or plasma neutrophil gelatinase-associated lipocalin (NGAL) more than 150 mg/dL
• • Opinion of the treating clinical team that patient was well resuscitated and sufficiently clinically stable for the intervention or by noninvasive or invasive measurements i.e. fluid accumulation at least 5% plus at least one of the following e.g. chest radiography, central venous pressure ≥ 8 mmHg, pulse pressure variation \< 13%, inferior vena cava collapsibility index \< 50% in spontaneously breathing patients or distensibility index \< 18% in mechanically ventilated patients
• Exclusion Criteria:
• • Baseline serum creatinine ≥ 2 mg/dL (male) and ≥ 1.5 mg/dL (female) within 3 months
• • Evidence of volume depletion at the time of furosemide administration or active bleeding
• • Evidence of obstructive uropathy, renal vein thrombosis or renal artery stenosis, thrombotic microangiopathy, glomerulonephritis, tumor lysis syndrome
• • History of renal allograft
• • Known pregnancy
• • Allergy or known sensitivity to loop diuretics
• • Need for emergency renal replacement therapy at randomization or evaluation by the clinical team that the renal replacement therapy should be deferred
• • Patient is moribund with expected death within 24 hr or whom survival to 28 days is unlikely due to an uncontrollable comorbidity (cardiac, pulmonary or hepatic end-stage disease; hepatorenal syndrome; poorly controlled cancer; severe post-anoxic encephalopathy; etc.)
• • Patients with advance directives issued expressing the desire not to be resuscitated
• • Prior treatment with RRT within 30 days