Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial)
Abstract Background The timing of initiation of renal replacement therapy (RRT) in severe acute kidney injury (AKI) remains controversial, with early initiation resulting in unnecessary therapy for some patients while expectant therapy may delay RRT for other patients. The furosemide stress test (FS...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2021-1 |
| _version_ | 1811222707378847744 |
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| author | Nuttha Lumlertgul Sadudee Peerapornratana Thananda Trakarnvanich Wanjak Pongsittisak Kajbundit Surasit Anan Chuasuwan Pleumjit Tankee Khajohn Tiranathanagul Kearkiat Praditpornsilpa Kriang Tungsanga Somchai Eiam-Ong John A. Kellum Nattachai Srisawat for the FST Study Group |
| author_facet | Nuttha Lumlertgul Sadudee Peerapornratana Thananda Trakarnvanich Wanjak Pongsittisak Kajbundit Surasit Anan Chuasuwan Pleumjit Tankee Khajohn Tiranathanagul Kearkiat Praditpornsilpa Kriang Tungsanga Somchai Eiam-Ong John A. Kellum Nattachai Srisawat for the FST Study Group |
| author_sort | Nuttha Lumlertgul |
| collection | DOAJ |
| description | Abstract Background The timing of initiation of renal replacement therapy (RRT) in severe acute kidney injury (AKI) remains controversial, with early initiation resulting in unnecessary therapy for some patients while expectant therapy may delay RRT for other patients. The furosemide stress test (FST) has been shown to predict the need for RRT and therefore could be used to exclude low-risk patients from enrollment in trials of RRT timing. We conducted this multicenter pilot study to determine whether FST could be used to screen patients at high risk for RRT and to determine the feasibility of incorporating FST into a trial of early initiation of RRT. Methods FST was performed using intravenous furosemide (1 mg/kg in furosemide-naive patients or 1.5 mg/kg in previous furosemide users). FST-nonresponsive patients (urine output less than 200 mL in 2 h) were then randomized to early (initiation within 6 h) or standard (initiation by urgent indication) RRT. Results FST was completed in all patients (100%). Only 6/44 (13.6%) FST-responsive patients ultimately received RRT while 47/60 (78.3%) nonresponders randomized to standard RRT either received RRT or died (P < 0.001). Among 118 FST-nonresponsive patients, 98.3% in the early RRT arm and 75% in the standard RRT arm received RRT. The adherence to the protocol was 94.8% and 100% in the early and standard RRT group, respectively. We observed no differences in 28-day mortality (62.1 versus 58.3%, P = 0.68), 7-day fluid balance, or RRT dependence at day 28. However, hypophosphatemia occurred more frequently in the early RRT arm (P = 0.002). Conclusion The furosemide stress test appears to be feasible and effective in identifying patients for randomization to different RRT initiation times. Our findings should guide implementation of large-scale randomized controlled trials for the timing of RRT initiation. Trial registration clinicaltrials.gov, NCT02730117. Registered 6 April 2016. |
| first_indexed | 2024-04-12T08:20:42Z |
| format | Article |
| id | doaj.art-28b65ce5cda54d7fb773a3f7dde19e0e |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-12T08:20:42Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-28b65ce5cda54d7fb773a3f7dde19e0e2022-12-22T03:40:36ZengBMCCritical Care1364-85352018-04-012211910.1186/s13054-018-2021-1Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial)Nuttha Lumlertgul0Sadudee Peerapornratana1Thananda Trakarnvanich2Wanjak Pongsittisak3Kajbundit Surasit4Anan Chuasuwan5Pleumjit Tankee6Khajohn Tiranathanagul7Kearkiat Praditpornsilpa8Kriang Tungsanga9Somchai Eiam-Ong10John A. Kellum11Nattachai Srisawat12for the FST Study GroupDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityRenal Division, Department of Medicine, Vajira Hospital, Navamindradhiraj UniversityRenal Division, Department of Medicine, Vajira Hospital, Navamindradhiraj UniversityNakhon Ping HospitalBhumibol Adulyadej HospitalVajira Phuket HospitalDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityThe Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of MedicineDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn UniversityAbstract Background The timing of initiation of renal replacement therapy (RRT) in severe acute kidney injury (AKI) remains controversial, with early initiation resulting in unnecessary therapy for some patients while expectant therapy may delay RRT for other patients. The furosemide stress test (FST) has been shown to predict the need for RRT and therefore could be used to exclude low-risk patients from enrollment in trials of RRT timing. We conducted this multicenter pilot study to determine whether FST could be used to screen patients at high risk for RRT and to determine the feasibility of incorporating FST into a trial of early initiation of RRT. Methods FST was performed using intravenous furosemide (1 mg/kg in furosemide-naive patients or 1.5 mg/kg in previous furosemide users). FST-nonresponsive patients (urine output less than 200 mL in 2 h) were then randomized to early (initiation within 6 h) or standard (initiation by urgent indication) RRT. Results FST was completed in all patients (100%). Only 6/44 (13.6%) FST-responsive patients ultimately received RRT while 47/60 (78.3%) nonresponders randomized to standard RRT either received RRT or died (P < 0.001). Among 118 FST-nonresponsive patients, 98.3% in the early RRT arm and 75% in the standard RRT arm received RRT. The adherence to the protocol was 94.8% and 100% in the early and standard RRT group, respectively. We observed no differences in 28-day mortality (62.1 versus 58.3%, P = 0.68), 7-day fluid balance, or RRT dependence at day 28. However, hypophosphatemia occurred more frequently in the early RRT arm (P = 0.002). Conclusion The furosemide stress test appears to be feasible and effective in identifying patients for randomization to different RRT initiation times. Our findings should guide implementation of large-scale randomized controlled trials for the timing of RRT initiation. Trial registration clinicaltrials.gov, NCT02730117. Registered 6 April 2016.http://link.springer.com/article/10.1186/s13054-018-2021-1Furosemide stress testAcute kidney injuryRenal replacement therapy |
| spellingShingle | Nuttha Lumlertgul Sadudee Peerapornratana Thananda Trakarnvanich Wanjak Pongsittisak Kajbundit Surasit Anan Chuasuwan Pleumjit Tankee Khajohn Tiranathanagul Kearkiat Praditpornsilpa Kriang Tungsanga Somchai Eiam-Ong John A. Kellum Nattachai Srisawat for the FST Study Group Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) Critical Care Furosemide stress test Acute kidney injury Renal replacement therapy |
| title | Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) |
| title_full | Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) |
| title_fullStr | Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) |
| title_full_unstemmed | Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) |
| title_short | Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial) |
| title_sort | early versus standard initiation of renal replacement therapy in furosemide stress test non responsive acute kidney injury patients the fst trial |
| topic | Furosemide stress test Acute kidney injury Renal replacement therapy |
| url | http://link.springer.com/article/10.1186/s13054-018-2021-1 |
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