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