Response to different furosemide doses predicts AKI progression in ICU patients with elevated plasma NGAL levels

Abstract

BackgroundFurosemide responsiveness (FR) is determined by urine output after furosemide administration and has recently been evaluated as a furosemide stress test (FST) for predicting severe acute kidney injury (AKI) progression. Although a standardized furosemide dose is required for FST, variable dosing is typically employed based on illness severity, including renal dysfunction in the clinical setting. This study aimed to evaluate whether FR with different furosemide doses can predict AKI progression. We further evaluated the combination of an AKI biomarker, plasma neutrophil gelatinase-associated lipocalin (NGAL), and FR for predicting AKI progression.ResultsWe retrospectively analyzed 95 patients who were treated with bolus furosemide in our medical–surgical intensive care unit. Patients who had already developed AKI stage 3 were excluded. A total of 18 patients developed AKI stage 3 within 1 week. Receiver operating curve analysis revealed that the area under the curve (AUC) values of FR and plasma NGAL were 0.87 (0.73–0.94) and 0.80 (0.67–0.88) for AKI progression, respectively. When plasma NGAL level was < 142 ng/mL, only one patient developed stage 3 AKI, indicating that plasma NGAL measurements were sufficient to predict AKI progression. We further evaluated the performance of FR in 51 patients with plasma NGAL levels > 142 ng/mL. FR was associated with AUC of 0.84 (0.67–0.94) for AKI progression in this population with high NGAL levels.ConclusionsAlthough different variable doses of furosemide were administered, FR revealed favorable efficacy for predicting AKI progression even in patients with high plasma NGAL levels. This suggests that a combination of FR and biomarkers can stratify the risk of AKI progression in a clinical setting.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0355-0) contains supplementary material, which is available to authorized users.

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

“…The diagnostic criteria for AKI were different in the eleven enrolled studies. Five of the studies (Elsaegh, 2018;Lumlertgul, 2018;Martínez, 2016;Matsuura, 2018;Vairakkani, 2019) [14][15][16][17][18] used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria [19]. Other studies used the Acute Kidney Injury Network (AKIN) criteria [20].…”

“…Vairakkani, 2019) [16][17][18] used the KDIGO stage 3 AKI as primary outcome. Two studies (Elsaegh, 2018; Saber, 2018) reported primary composite outcome consist of AKI progression and RRT [14,24].…”

“…Among those patients, 517 patients and 1,017 patients, respectively, had reported outcomes of AKI progression (including the need for RRT) or RRT. Most of the enrolled studies used prospective cohorts and four of then used non-prospective study designs or insufficient information about study designs (Chawla, 2013; Matsuura, 2018; Sakhuja, 2019; Vairakkani, 2019) [8,17,18,25]. All of the studies, except the two by Matsuura et al and Sakhuja et al, used a standard furosemide dose, which is 1 mg/kg for the furosemide naive patients and 1.5 mg/kg for those patients exposed to furosemide within 7 days prior to FST [17,25].…”

“…Most of the enrolled studies used prospective cohorts and four of then used non-prospective study designs or insufficient information about study designs (Chawla, 2013; Matsuura, 2018; Sakhuja, 2019; Vairakkani, 2019) [8,17,18,25]. All of the studies, except the two by Matsuura et al and Sakhuja et al, used a standard furosemide dose, which is 1 mg/kg for the furosemide naive patients and 1.5 mg/kg for those patients exposed to furosemide within 7 days prior to FST [17,25]. Matsuura et al used a complex cut-off value, which presented as urine volume divided by the administered furosemide dose (specifically, 3.9 ml of urine output 2 hours after per mg furosemide administration) [17].…”

“…All of the studies, except the two by Matsuura et al and Sakhuja et al, used a standard furosemide dose, which is 1 mg/kg for the furosemide naive patients and 1.5 mg/kg for those patients exposed to furosemide within 7 days prior to FST [17,25]. Matsuura et al used a complex cut-off value, which presented as urine volume divided by the administered furosemide dose (specifically, 3.9 ml of urine output 2 hours after per mg furosemide administration) [17]. In the study by Sakhuja et al, the used dose of furosemide was at least 1mg/kg [25].…”