2016, Number 4
PDF size: 184.21 Kb.
ABSTRACTIntroduction: Several factors are associated with the presence of acute kidney injury (AKI) in critical ill patients, that is the reason because many authors have attempted to develop diagnostic tests to determine the performance and behavior of renal function. The furosemide stress test (FST) is an easy and accessible strategy in our environment for this purpose. This study evaluated the diagnostic performance of the FST in the development of AKI stage 3.
Methods: Through a prospective cohort (September 2014 to September 2015) we evaluated patient whit AKI stages 1 and 2; previously to the FST, volume status was determined by focused ultrasound and proceeded to administer 1 mg/kg single dose of furosemide. Positive test was defined as a urine output › 200 ml in two hours later. We followed for six hours diuresis, progression to KDIGO 3, the need for renal replacement therapy (RRT) and mortality.
Results: 20 patients with AKI KDIGO 1 and 2 were identified, for the analysis they were classified in responders (R) and non-responders group (NR) to the test. NR group was formed by 4 patients who represented a correlation with progression KDIGO 3 and RRT, p = 0.003 and p = 0.013 respectively; it was documented an area under the curve (ROC) of 0.83 (95% CI 0.60 to 0.96) and 0.84 (95 % 0.61 to 0.96), no association was found with mortality.
Conclusions: FST adequately predicts the behavior of renal function; this is consistent with other studies but a bigger study population is required to corroborate the accuracy of the data mentioned above.
Liaño F, Pascual J et al. Epidemiology of acute renal failure: a prospective, multicenter community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50:811-818.
Cartin-Ceba R1, Kashiouris M, Plataki M, Kor DJ, Gajic O, Casey ET. Risk factors for development of acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies. Crit Care Res Pract. 2012;2012:691013.
Cruz DN, Ferrer-Nadal A, Piccinni P, Goldstein SL, Chawla LS, Alessandri E et al. Utilization of small changes in serum creatinine with clinical risk factors to assess the risk of AKI in critical ill adults. Clin J Am Soc Nephrol. 2014;9:663-672.
Chawla LS, Davison DL, Brasha-Mitchell E, Koyner JL, Arthur JM, Shaw AD et al. Development a standardization of a furosemide stress test to predict the Severity of Acute Kidney Injury. Crit Care. 2013;17:R207.
KDIGO Clinical Practice Guideline for Acute Kidney Injury; 2012.
Chawla LS, Dommu A, Berger A, Shih s, Patel S. Urinary sediment cast scoring index for acute kidney injury: a pilot study. Nephron Clin Pract. 2008;110(3):c145-150.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:881-829.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendoça A, Bruining H. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707-710.
Ho KM, Power BM. Benefits and risk of furosemide in acute kidney injury. Anaesthesia. 2010;65(3):283-293.
Heyman SN, Rosen S, Epstein FH, Spokes K, Brezis ML. Loop diuretics reduce hypoxic damage to proximal tubules of the isolated perfused rat Kidney. Kidney Int. 1994;45:981-985.
Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15:R72.