TY - JOUR
T1 - Role of Loop Diuretic Challenge in Stage 3 Acute Kidney Injury
AU - Sakhuja, A.
AU - Bandak, Ghassan
AU - Barreto, Erin F.
AU - Vallabhajosyula, Saraschandra
AU - Jentzer, J.
AU - Albright, Robert
AU - Kashani, Kianoush B.
N1 - Funding Information:
Grant Support: This work was supported by CTSA grant UL1 TR002377 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. Grant Support: This work was supported by CTSA grant UL1 TR002377 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. Grant Support: This work was supported by CTSA grant UL1 TR002377 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health.
Publisher Copyright:
© 2019 Mayo Foundation for Medical Education and Research
PY - 2019/8
Y1 - 2019/8
N2 - Objective: To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3. Patients and Methods: Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours. Results: Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively. Conclusion: Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.
AB - Objective: To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3. Patients and Methods: Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours. Results: Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively. Conclusion: Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.
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U2 - 10.1016/j.mayocp.2019.01.040
DO - 10.1016/j.mayocp.2019.01.040
M3 - Article
C2 - 31279541
AN - SCOPUS:85068229391
SN - 0025-6196
VL - 94
SP - 1509
EP - 1515
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 8
ER -