Overview

Furosemide Stress Test Guiding Initiation of Renal Replacement Therapy

Status:
Completed
Trial end date:
2017-07-01
Target enrollment:
0
Participant gender:
All
Summary
Does Early Initiation of Renal Replacement Therapy Have an Impact on 7-day Fluid Balance in Critically Ill Patients with Acute Kidney Injury with Positive Furosemide Stress Test?: a Multicenter Randomized Controlled Trial
Phase:
N/A
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Chulalongkorn University
Treatments:
Anti-Bacterial Agents
Cephalosporins
Dobutamine
Dopamine
Furosemide
Milrinone
Norepinephrine
Vasoconstrictor Agents
Criteria
Inclusion Criteria:

- Age older than 18 years old and admission in an ICU

- Acute kidney injury (defined by serum creatinine increase ≥ 0.3 mg/dL or urine output
≤ 0.5 mL/kg/hour according to KDIGO criteria)

- Informed consent provided by the patient or person with decisional responsibility

- Indwelling bladder catheter

- Documented cause of acute kidney injury from acute tubular necrosis e.g. presence of
granular or epithelial casts on urine sediment, FeNa more than 1%, Feurea more than
50%, urine or plasma neutrophil gelatinase-associated lipocalin (NGAL) more than 150
mg/dL

- Opinion of the treating clinical team that patient was well resuscitated and
sufficiently clinically stable for the intervention or by noninvasive or invasive
measurements i.e. fluid accumulation at least 5% plus at least one of the following
e.g. chest radiography, central venous pressure ≥ 8 mmHg, pulse pressure variation <
13%, inferior vena cava collapsibility index < 50% in spontaneously breathing patients
or distensibility index < 18% in mechanically ventilated patients

Exclusion Criteria:

- Baseline serum creatinine ≥ 2 mg/dL (male) and ≥ 1.5 mg/dL (female) within 3 months

- Evidence of volume depletion at the time of furosemide administration or active
bleeding

- Evidence of obstructive uropathy, renal vein thrombosis or renal artery stenosis,
thrombotic microangiopathy, glomerulonephritis, tumor lysis syndrome

- History of renal allograft

- Known pregnancy

- Allergy or known sensitivity to loop diuretics

- Need for emergency renal replacement therapy at randomization or evaluation by the
clinical team that the renal replacement therapy should be deferred

- Patient is moribund with expected death within 24 hr or whom survival to 28 days is
unlikely due to an uncontrollable comorbidity (cardiac, pulmonary or hepatic end-stage
disease; hepatorenal syndrome; poorly controlled cancer; severe post-anoxic
encephalopathy; etc.)

- Patients with advance directives issued expressing the desire not to be resuscitated

- Prior treatment with RRT within 30 days