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Furosemide stress test to predict acute kidney injury progression in critically ill children

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Abstract

Background

Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited.

Methods

Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated.

Results

Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84–1.0) and 0.96 ± 0.03 (95% CI 0.9–1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy.

Conclusions

Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable. Data subsets are available with the corresponding author.

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Authors and Affiliations

  1. Pediatric Nephrology Services, Department of Paediatrics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, India

    Sudarsan Krishnasamy

  2. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Aditi Sinha & Pankaj Hari

  3. Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Rakesh Lodha & Jhuma Sankar

  4. Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Mohamad Tarik & Lakshmy Ramakrishnan

  5. Director Paediatrics and Senior Consultant Pediatric Nephrology, Indraprastha Apollo Hospitals, New Delhi, India

    Arvind Bagga

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Contributions

SK, AS, JS, RL, AB, and PH managed the patients. SK participated in study protocol preparation, recruited patients, participated in data analysis, and drafted the first version of the manuscript. AS, AB, and PH conceptualized the study design, interpreted the data, and critically revised the manuscript. JS and RL assisted in protocol preparation, recruitment of patients, and drafting the manuscript. MT and LR helped in performing biomarkers for the study. All authors contributed to protocol preparation, drafting of the manuscript, and approved the final version of the manuscript. PH shall act as the corresponding author and guarantor of the paper.

Corresponding author

Correspondence to Pankaj Hari.

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Consent to participate and publish the data

The authors affirm that human research participants provided informed consent to participate in the study and publish the data.

Ethics approval

The study was approved by the Institute Ethics Committee (IECPG-590/24.10.2019, RT-15/28.11.2019, titled “Furosemide stress test in predicting progression to AKI stage III in children admitted to the ICU with early stages of AKI”).

Conflict of interest

The authors declare no competing interests.

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Krishnasamy, S., Sinha, A., Lodha, R. et al. Furosemide stress test to predict acute kidney injury progression in critically ill children. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06387-5

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