title: Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity.
abstract: 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.
authors: Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois;
authors: Jay L
authors: JL
authors: Koyner
authors: Department of Anesthesiology and Critical Care Medicine and.
authors: Danielle L
authors: DL
authors: Davison
authors: Department of Anesthesiology and Critical Care Medicine and.
authors: Ermira
authors: E
authors: Brasha-Mitchell
authors: Department of Anesthesiology and Critical Care Medicine and.
authors: Divya M
authors: DM
authors: Chalikonda
authors: Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina;
authors: John M
authors: JM
authors: Arthur
authors: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee;
authors: Andrew D
authors: AD
authors: Shaw
authors: Renal Division, University of Tennessee College of Medicine at Chattanooga, Chattanooga, Tennessee;
authors: James A
authors: JA
authors: Tumlin
authors: Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois;
authors: Sharon A
authors: SA
authors: Trevino
authors: Division of Nephrology and Hypertension, Cincinnati Children's Hospital, Cincinnati, Ohio; and.
authors: Michael R
authors: MR
authors: Bennett
authors: Department of Medicine, George Washington University Medical Center, Washington DC;
authors: Paul L
authors: PL
authors: Kimmel
authors: Department of Anesthesiology and Critical Care Medicine and.
authors: Michael G
authors: MG
authors: Seneff
authors: Department of Medicine, Division of Intensive Care Medicine and Division of Nephrology, Washington DC Veterans Affairs Medical Center, Washington, DC minkchawla@gmail.com.
authors: Lakhmir S
authors: LS
authors: Chawla
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D000419:Albuminuria / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine*; D003404:Creatinine / Q000652:urine; D018450:Disease Progression; D004232:Diuretics; D005260:Female; D005665:Furosemide; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D018969:Insulin-Like Growth Factor Binding Proteins / Q000652:urine; D020382:Interleukin-18 / Q000652:urine; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D011991:Receptors, Virus; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood / Q000652:urine; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000652:urine; D058949:Uromodulin / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D004232:Diuretics; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C000589760:IL18 protein, human; D018969:Insulin-Like Growth Factor Binding Proteins; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; C560823:TIMP2 protein, human; D058949:Uromodulin; C102529:insulin-like growth factor binding protein-related protein 1; D019716:Tissue Inhibitor of Metalloproteinase-2; D005665:Furosemide; D012964:Sodium; D003404:Creatinine
keywords: acute renal failure; clinical nephrology; diuretics
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