Furosemide Stress Test to Predict Successful Liberation From RRT

Evaluation of the Furosemide Stress Test to Predict Successful Liberation From Renal Replacement Therapy in Critically Ill Patients

The proposed study will evaluate if a standardised dose of furosemide administered in the 12 hours after RRT liberation can predict successful liberation in critically ill patients. The dose that will be administered is in accordance with the prescribing information.

Response to furosemide administration is commonly used in clinical practice to assess a patient's potential for RRT liberation. However, this administration is not standardized and practices varies greatly. Rapid recognition of unsuccessful RRT liberation is crucial to avoid further complications such as fluid overload or acid-base and electrolyte disorders. The FST corresponds to the intravenous administration of 1 mg/kg (1.5 mg/kg in previously exposed patients) of furosemide and the assessment of resulting diuresis in the following two hours. FST is able to predict progression from AKI stage I and II to stage III with a high sensitivity (87.1%) and specificity (84.1%), area under the ROC curve 0.87. However, the ability of FST to predict RRT liberation has never been formally assessed.

Inclusion Criteria:

• Receiving continuous or intermittent RRT for AKI
• Having an indwelling urinary catheter
• Clinical decision by physician in charge to attempt RRT liberation
• lnformed consent signed by the patient himself / legal representative or authorization received from independent physician

Exclusion Criteria:

• Electrolyte disturbances or hemodynamic instability precluding the use of furosemide (sodium > 155 mmol/L and/or potassium < 3.0 mmol/L and/or metabolic alkalosis > 7.50 and/or mean arterial pressure < 60 mmHg)
• Known furosemide allergy
• Urine output ≥ 100 mL/h for at least two hours
• Recent (< 24 hours) FST
• Known end-stage chronic renal disease at ICU admission
• Withdrawal of life support decision taken before inclusion
• Patient already participating in conflicting research study
• Patient having already participated in this current study
• Any other contraindication of furosemide