scholarly journals Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial)

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Nuttha Lumlertgul ◽  
◽  
Sadudee Peerapornratana ◽  
Thananda Trakarnvanich ◽  
Wanjak Pongsittisak ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Stress Test ◽  
Kidney Injury

scholarly journals Furosemide stress test as a predictive marker of acute kidney injury progression or renal replacement therapy: a systemic review and meta-analysis

2020 ◽  
Author(s):  
Jia-Jin Chen ◽  
Chih-Hsiang Chang ◽  
Yen Ta Huang ◽  
George Kuo
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Diagnostic Accuracy ◽  
Replacement Therapy ◽  
Sensitivity And Specificity ◽  
Odds Ratio ◽  
Diagnostic Performance ◽  
Stress Test ◽  
Kidney Injury ◽  
Diagnostic Odds Ratio

Abstract Background: The use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been described in several trials. However, the diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Cochrane databases up to March, 2020. The diagnostic performance of the FST (in terms of sensitivity, specificity, number of events, true positive, false positive) was extracted and evaluated. Results: We identified eleven trials that enrolled a total of 1366 patients, including 517 patients and 1017 patients for whom the outcomes in terms of AKI stage progression and renal replacement therapy (RRT), respectively, were reported. The pooled sensitivity and specificity results of the FST for AKI progression prediction were 0.81 (95% CI: 0.74 - 0.87) and 0.88 (95% CI: 0.82- 0.92), respectively. The pooled positive likelihood ratio (LR) was 5.45 (95% CI: 3.96-7.50), the pooled negative LR was 0.26 (95% CI: 0.19-0.36), and the pooled diagnostic odds ratio (DOR) was 29.69 (95% CI: 17.00-51.85). The summary receiver operating characteristics (SROC) with pooled diagnostic accuracy was 0.88. The diagnostic performance of the FST in predicting AKI progression was not affected by different AKI criteria or underlying chronic kidney disease. The pooled sensitivity and specificity results of the FST for RRT prediction were 0.84 (95% CI: 0.72-0.91) and 0.77 (95% CI: 0.64-0.87), respectively. The pooled positive LR and pooled negative LR were 3.16 (95% CI: 2.06-4.86) and 0.25 (95% CI: 0.14-0.44), respectively. The pooled diagnostic odds ratio (DOR) was 13.59 (95% CI: 5.74-32.17) and SROC with pooled diagnostic accuracy was 0.86. The diagnostic performance of FST for RRT prediction is better in stage 1-2 AKI comparing to stage 3 AKI (relative DOR: 5.75, 95% CI: 2.51-13.33) Conclusion: The FST is a simple tool for the identification of AKI populations at high risk of AKI progression and the need for RRT and the diagnostic performance of FST in RRT prediction is better in early AKI population.

scholarly journals Furosemide stress test as a predictive marker of acute kidney injury progression or renal replacement therapy: a systemic review and meta-analysis

2020 ◽  
Author(s):  
Jia-Jin Chen ◽  
Chih-Hsiang Chang ◽  
Yen Ta Huang ◽  
George Kuo
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Diagnostic Accuracy ◽  
Replacement Therapy ◽  
Sensitivity And Specificity ◽  
Odds Ratio ◽  
Diagnostic Performance ◽  
Stress Test ◽  
Kidney Injury ◽  
Diagnostic Odds Ratio

Abstract Background The use of the furosemide stress test (FST) as an acute kidney injury (AKI) severity marker has been discussed in several different trials. However, the diagnostic performance of the FST in predicting AKI progression has not yet been fully discussed. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, MEDLINE and Cochrane databases up to December, 31 2019. The diagnostic performance of the FST (in terms of sensitivity, specificity, number of events, number of true positives, and number of false positives) was extracted and evaluated. Results We identified nine trials that enrolled a total of 1296 patients, including 432 patients and 864 patients for whom the outcomes in terms of AKI stage progression and renal replacement therapy (RRT), respectively, were reported. The pooled sensitivity and specificity results of the FST for AKI progression prediction were 0.83 (95% CI: 0.76 - 0.89) and 0.87 (95% CI: 0.80 - 0.92), respectively. The pooled positive likelihood ratio (LR) was 5.27 (95% CI: 3.75-7.39), the pooled negative LR was 0.22 (95% CI: 0.15 - 0.32), and the pooled diagnostic odds ratio (DOR) was 29.34 (95% CI: 16.35-52.66). The summary receiver operating characteristics (SROC) with pooled diagnostic accuracy was 0.87. The diagnostic performance of the FST in predicting AKI progression was not affected by different AKI criteria (relative DOR: 1.04, 95% CI: 0.18 - 5.94) or underlying chronic kidney disease (relative DOR: 0.66, 95% CI: 0.08 - 5.70). The pooled sensitivity and specificity results of the FST for RRT prediction were 0.87 (95% CI: 0.76 - 0.93) and 0.71(95% CI: 0.56 -0.83), respectively. The pooled positive LR and pooled negative LR were 2.85 (95% CI: 1.81-4.48) and 0.22(95% CI: 0.11- 0.43), respectively. The pooled diagnostic odds ratio (DOR) was 13.36 (95% CI: 4.79-37.27) and SROC with pooled diagnostic accuracy was 0.87. Conclusion The FST is a simple tool for the identification of AKI populations at high risk of AKI progression, but the diagnostic performance of FST in RRT prediction is suboptimal.

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

scholarly journals Renal replacement therapy in critical care in patients with acute kidney injury

2018 ◽  
Vol 51 (2) ◽  
pp. 141-148
Author(s):  
Shigeo Negi ◽  
Daisuke Koreeda ◽  
Masaki Higashiura ◽  
Takuro Yano ◽  
Sou Kobayashi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury

scholarly journals Comparison of Approaches for Prediction of Renal Replacement Therapy-Free Survival in Patients with Acute Kidney Injury

2021 ◽  
pp. 1-7
Author(s):  
Pattharawin Pattharanitima ◽  
Akhil Vaid ◽  
Suraj K. Jaladanki ◽  
Ishan Paranjpe ◽  
Ross O’Hagan ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Support Vector ◽  
Adaptive Boosting ◽  
Free Survival ◽  
Extreme Gradient Boosting

Background/Aims: Acute kidney injury (AKI) in critically ill patients is common, and continuous renal replacement therapy (CRRT) is a preferred mode of renal replacement therapy (RRT) in hemodynamically unstable patients. Prediction of clinical outcomes in patients on CRRT is challenging. We utilized several approaches to predict RRT-free survival (RRTFS) in critically ill patients with AKI requiring CRRT. Methods: We used the Medical Information Mart for Intensive Care (MIMIC-III) database to identify patients ≥18 years old with AKI on CRRT, after excluding patients who had ESRD on chronic dialysis, and kidney transplantation. We defined RRTFS as patients who were discharged alive and did not require RRT ≥7 days prior to hospital discharge. We utilized all available biomedical data up to CRRT initiation. We evaluated 7 approaches, including logistic regression (LR), random forest (RF), support vector machine (SVM), adaptive boosting (AdaBoost), extreme gradient boosting (XGBoost), multilayer perceptron (MLP), and MLP with long short-term memory (MLP + LSTM). We evaluated model performance by using area under the receiver operating characteristic (AUROC) curves. Results: Out of 684 patients with AKI on CRRT, 205 (30%) patients had RRTFS. The median age of patients was 63 years and their median Simplified Acute Physiology Score (SAPS) II was 67 (interquartile range 52–84). The MLP + LSTM showed the highest AUROC (95% CI) of 0.70 (0.67–0.73), followed by MLP 0.59 (0.54–0.64), LR 0.57 (0.52–0.62), SVM 0.51 (0.46–0.56), AdaBoost 0.51 (0.46–0.55), RF 0.44 (0.39–0.48), and XGBoost 0.43 (CI 0.38–0.47). Conclusions: A MLP + LSTM model outperformed other approaches for predicting RRTFS. Performance could be further improved by incorporating other data types.

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