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Background <p>The optimal time for initiating kidney replacement therapy (KRT) in acute kidney injury (AKI) has been extensively studied in recent years. In contrast, there are currently insufficient data on the best time to discontinue KRT. One diagnostic option to unmask tubular reserve and indirectly estimate the glomerular filtration rate is the furosemide stress test (FST).</p> Methods <p>We conducted a prospective, observational single-center trial. A FST was carried out in patients who developed spontaneous diuresis (SD) during ongoing KRT with a urine output of at least 400 ml in 24 h without any diuretic therapy. A positive FST was defined with urine output &gt; 200 ml within 2 h following intravenous furosemide application. Follow-up was performed for 7 days and the need to restart KRT was assessed daily.</p> Results <p>After 100 patients were enrolled in the trial, 98 patients were eligible for further evaluation. 76 patients were FST-positive, while 22 patients were FST-negative. Resumption of KRT within the 7-day follow-up was required in only 14.5% of the FST-positive, but 72.7% of the FST-negative patients (<i>p </i>&lt; 0.001). The urine output after FST was also significantly associated with successful release from KRT (AUC 0.87; <i>p</i> &lt; 0.001).</p> Conclusions <p>In critically ill patients with recovery of SD &gt; 400ml/d during ongoing KRT, the FST helps to identify patients who can be successfully liberated from KRT. By detecting the tubular reserve using FST, the possibility of short-term kidney recovery after AKI can be estimated.</p> Trial registration <p>German Clinical Trials Registry (DRKS00030560); date of registration 18/11/2022. <a href="https://drks.de/search/de/trial/DRKS00030560">https://drks.de/search/de/trial/DRKS00030560</a>.</p>

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Spontaneous diuresis in combination with furosemide stress test (SD-FST) as predictor for successful liberation from kidney replacement therapy: a prospective observational study

  • 期刊论文

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  • 发表日期：

    2025年5月26日

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  • Lorenz Weidhase,
  • Stephanie Wille,
  • Helene Foede,
  • Fanny Gilch,
  • Meinhard Mende,
  • Christina Scharf-Janßen,
  • Sirak Petros,
  • Jonathan de Fallois

摘要

Background

The optimal time for initiating kidney replacement therapy (KRT) in acute kidney injury (AKI) has been extensively studied in recent years. In contrast, there are currently insufficient data on the best time to discontinue KRT. One diagnostic option to unmask tubular reserve and indirectly estimate the glomerular filtration rate is the furosemide stress test (FST).

Methods

We conducted a prospective, observational single-center trial. A FST was carried out in patients who developed spontaneous diuresis (SD) during ongoing KRT with a urine output of at least 400 ml in 24 h without any diuretic therapy. A positive FST was defined with urine output > 200 ml within 2 h following intravenous furosemide application. Follow-up was performed for 7 days and the need to restart KRT was assessed daily.

Results

After 100 patients were enrolled in the trial, 98 patients were eligible for further evaluation. 76 patients were FST-positive, while 22 patients were FST-negative. Resumption of KRT within the 7-day follow-up was required in only 14.5% of the FST-positive, but 72.7% of the FST-negative patients (p < 0.001). The urine output after FST was also significantly associated with successful release from KRT (AUC 0.87; p < 0.001).

Conclusions

In critically ill patients with recovery of SD > 400ml/d during ongoing KRT, the FST helps to identify patients who can be successfully liberated from KRT. By detecting the tubular reserve using FST, the possibility of short-term kidney recovery after AKI can be estimated.

Trial registration

German Clinical Trials Registry (DRKS00030560); date of registration 18/11/2022. https://drks.de/search/de/trial/DRKS00030560.