Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity.

Koyner JL, Davison DL, Brasha-Mitchell E, Chalikonda DM, Arthur JM, Shaw AD, Tumlin JA, Trevino SA, Bennett MR, Kimmel PL, Seneff MG, Chawla LS
J Am Soc Nephrol. 2015 26 (8): 2023-31

PMID: 25655065 · PMCID: PMC4520172 · DOI:10.1681/ASN.2014060535

Clinicians have access to limited tools that predict which patients with early AKI will progress to more severe stages. In early AKI, urine output after a furosemide stress test (FST), which involves intravenous administration of furosemide (1.0 or 1.5 mg/kg), can predict the development of stage 3 AKI. We measured several AKI biomarkers in our previously published cohort of 77 patients with early AKI who received an FST and evaluated the ability of FST urine output and biomarkers to predict the development of stage 3 AKI (n=25 [32.5%]), receipt of RRT (n=11 [14.2%]), or inpatient mortality (n=16 [20.7%]). With an area under the curve (AUC)±SEM of 0.87±0.09 (P<0.0001), 2-hour urine output after FST was significantly better than each urinary biomarker tested in predicting progression to stage 3 (P<0.05). FST urine output was the only biomarker to significantly predict RRT (0.86±0.08; P=0.001). Regardless of the end point, combining FST urine output with individual biomarkers using logistic regression did not significantly improve risk stratification (ΔAUC, P>0.10 for all). When FST urine output was assessed in patients with increased biomarker levels, the AUC for progression to stage 3 improved to 0.90±0.06 and the AUC for receipt of RRT improved to 0.91±0.08. Overall, in the setting of early AKI, FST urine output outperformed biochemical biomarkers for prediction of progressive AKI, need for RRT, and inpatient mortality. Using a FST in patients with increased biomarker levels improves risk stratification, although further research is needed.

Copyright © 2015 by the American Society of Nephrology.

MeSH Terms (25)

Acute-Phase Proteins Acute Kidney Injury Aged Albuminuria Biomarkers Creatinine Disease Progression Diuretics Female Furosemide Hepatitis A Virus Cellular Receptor 1 Humans Insulin-Like Growth Factor Binding Proteins Interleukin-18 Lipocalin-2 Lipocalins Male Membrane Glycoproteins Middle Aged Proto-Oncogene Proteins Receptors, Virus Severity of Illness Index Sodium Tissue Inhibitor of Metalloproteinase-2 Uromodulin

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