Lack of Furosemide Responsiveness Predicts Acute Kidney Injury in Infants After Cardiac Surgery

Kakajiwala, Aadil; Kim, Ji Young; Hughes, John Z.; Costarino, Andrew T.; Ferguson, John G.; Gaynor, J. William; Furth, Susan L.; Blinder, Joshua J.

doi:10.1016/j.athoracsur.2017.03.015

Cited by 39 publications

(30 citation statements)

References 27 publications

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“…Patients with AKI have reduced response to furosemide, and lack of furosemide responsiveness is predictive of AKI development in children undergoing cardiac surgery 160,161 . In adults, unresponsiveness in a furosemide stress test (urine output below 200 mL in 2 h after treatment with 1 mg/kg intravenous furosemide in furosemide-naive patients or 1.5 mg/kg in patients who had received furosemide within the past 7 days) identifies patients at high risk for AKI progression and subsequent use of RRT 145 .…”

Section: Human Albumin Solution For Renal Protectionmentioning

confidence: 99%

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Wiedermann¹

2020

Current Medical Research and Opinion

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Objective: Positive fluid balance is common among critically ill patients and leads to worse outcomes, particularly in sepsis, acute respiratory distress syndrome, and acute kidney injury. Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload. Use of human albumin solutions has been investigated in different phases of restrictive fluid resuscitation, and this narrative literature review was undertaken to evaluate hypoalbuminemia and the roles of human serum albumin with respect to hypovolemia and its management.

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Section: Human Albumin Solution For Renal Protectionmentioning

confidence: 99%

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Wiedermann¹

2020

Current Medical Research and Opinion

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“…articles were screened based on their titles and abstracts in order to identify the potentially relevant articles, the full texts of which then were downloaded and reviewed to further determine their eligibility for inclusion in the final analysis. Of the 29 articles, two [32,33] was suspected of using a duplicate cohort from another study [8], five were focused on child populations [11,12,[34][35][36], and three were based on kidney transplant outcomes [9,10,37]. Meanwhile, five studies reported different outcomes of interest and the remaining three did not report sufficient information for analysis [38][39][40][41][42][43][44][45] (Additional profile 1: Supplementary Table 2).…”

Section: Literature Searchmentioning

confidence: 99%

“…Several following studies also utilized FST to predict AKI progression or RRT prediction, but with heterogeneity in AKI criteria, cut-off value of urine output, duration of monitor or study designs. A few recent studies used FST to predict delayed graft function after kidney transplant [9,10], and others focused on child populations [11,12]. As such, in order to more effectively explore the diagnostic accuracy of the FST to predict AKI progression and RRT initiation, we conducted this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagnostic test accuracy guidelines [13].…”

Section: Introductionmentioning

confidence: 99%

Furosemide stress test as a predictive marker of acute kidney injury progression or renal replacement therapy: a systemic review and meta-analysis

Chen

Chang

Huang³

et al. 2020

Preprint

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Background: The use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been described in several trials. However, the diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed.Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Cochrane databases up to March, 2020. The diagnostic performance of the FST (in terms of sensitivity, specificity, number of events, true positive, false positive) was extracted and evaluated.Results: We identified eleven trials that enrolled a total of 1366 patients, including 517 patients and 1017 patients for whom the outcomes in terms of AKI stage progression and renal replacement therapy (RRT), respectively, were reported. The pooled sensitivity and specificity results of the FST for AKI progression prediction were 0.81 (95% CI: 0.74 -0.87) and 0.88 (95% CI: 0.82-0.92), respectively.The pooled positive likelihood ratio (LR) was 5.45 (95% CI: 3.96-7.50), the pooled negative LR was 0.26 (95% CI: 0.19-0.36), and the pooled diagnostic odds ratio (DOR) was 29.69 (95% CI: 17.00-51.85). The summary receiver operating characteristics (SROC) with pooled diagnostic accuracy was 0.88. The diagnostic performance of the FST in predicting AKI progression was not affected by different AKI criteria or underlying chronic kidney disease. The pooled sensitivity and specificity results of the FST for RRT prediction were 0.84 (95% CI: 0.72-0.91) and 0.77 (95% CI: 0.64-0.87), respectively. The pooled positive LR and pooled negative LR were 3.16 (95% CI: 2.06-4.86) and 0.25 (95% CI: 0.14-0.44), respectively. The pooled diagnostic odds ratio (DOR) was 13.59 (95% CI: 5.74-32.17) and SROC with pooled diagnostic accuracy was 0.86. The diagnostic performance of FST for RRT prediction is better in stage 1-2 AKI comparing to stage 3 AKI (relative DOR: 5.75, 95% CI: 2.51- 13.33)Conclusion: The FST is a simple tool for the identification of AKI populations at high risk of AKI progression and the need for RRT and the diagnostic performance of FST in RRT prediction is better in early AKI population. Study SelectionAfter the initial screening, the two investigators Jia Jin Chen (JJ-C) and George Kuo (G-K) independently determined the eligibility of the identified studies based on evaluations of their titles, abstracts, and, subsequently, full texts. Any differences in opinion regarding eligibility was resolved by consensus through discussion with Chih-Hsiang Chang. The full text of any article that was deemed potentially relevant was retrieved online. A study was included if it met the criteria of adult humans as its population, and reported the protocol and cut-off point of the FST. We enrolled studies with primary or secondary outcomes reporting the diagnostic value of the FST for AKI progression, RRT, or mortality.Studies were excluded if they met one or more of the following criteria: (1) focused on a population with solid organ or hematopoietic ...

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“…Several studies have examined whether lack of post-operative diuretic responsiveness has utility as an early acute kidney injury predictor according to modified kidney disease improving global outcomes criteria. 38,39 The Neonatal and Paediatric Heart and Renal Outcomes Network collects hourly urine output for the first 8 hours after initial diuretic administration. This will permit a more detailed examination of diuretic responsiveness and acute kidney prediction among the 1162 subjects receiving furosemide within the first 24 post-operative hours.…”

Section: Diuretic Responsiveness Predict Post-operative Cardiac Surgementioning

confidence: 99%

Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Gist

Blinder

Bailly³

et al. 2019

Cardiol Young

Self Cite

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Background:Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.Methods:The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.Results:A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).Conclusions:Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.

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Lack of Furosemide Responsiveness Predicts Acute Kidney Injury in Infants After Cardiac Surgery

Abstract: After correcting serum creatinine for fluid balance and adjusting for surgical complexity, LFR performs fairly at 2 hours, whereas at 6 hours, LFR is a good AKI predictor. Prospective studies are needed to validate whether diuretic responsiveness predicts AKI.

Cited by 39 publications

References 27 publications

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients

Furosemide stress test as a predictive marker of acute kidney injury progression or renal replacement therapy: a systemic review and meta-analysis

Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

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