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

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.

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

10.21203/rs.2.23355/v1 ◽

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.

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

Critical Care ◽

10.1186/s13054-018-2021-1 ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 35

Author(s):

Nuttha Lumlertgul ◽

◽

Sadudee Peerapornratana ◽

Thananda Trakarnvanich ◽

Wanjak Pongsittisak ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Stress Test ◽

Kidney Injury

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Meta-Analysis: Urinary Calprotectin for Discrimination of Intrinsic and Prerenal Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm8010074 ◽

2019 ◽

Vol 8 (1) ◽

pp. 74 ◽

Cited By ~ 2

Author(s):

Jia-Jin Chen ◽

Pei-Chun Fan ◽

George Kou ◽

Su-Wei Chang ◽

Yi-Ting Chen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Pediatric Population ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Kidney Injury ◽

Diagnostic Odds Ratio ◽

Summary Receiver Operating Characteristic ◽

Significant Difference

Background: Urinary calprotectin is a novel biomarker that distinguishes between intrinsic or prerenal acute kidney injury (AKI) in different studies. However, these studies were based on different populations and different AKI criteria. We evaluated the diagnostic accuracy of urinary calprotectin and compared its diagnostic performance in different AKI criteria and study populations. Method: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Embase, and the Cochrane database up to September 2018. The diagnostic performance of urinary calprotectin (sensitivity, specificity, predictive ratio, and cutoff point) was extracted and evaluated. Result: This study included six studies with a total of 502 patients. The pooled sensitivity and specificity were 0.90 and 0.93, respectively. The pooled positive likelihood ratio (LR) was 15.15, and the negative LR was 0.11. The symmetric summary receiver operating characteristic (symmetric SROC) with pooled diagnostic accuracy was 0.9667. The relative diagnostic odds ratio (RDOC) of the adult to pediatric population and RDOCs of different acute kidney injury criteria showed no significant difference in their diagnostic accuracy. Conclusion: Urinary calprotectin is a good diagnostic tool for the discrimination of intrinsic and prerenal AKI under careful inspection after exclusion of urinary tract infection and urogenital malignancies. Its performance is not affected by different AKI criteria and adult or pediatric populations.

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

Critical Care ◽

10.1186/s13054-020-02912-8 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Jia-Jin Chen ◽

Chih-Hsiang Chang ◽

Yen-Ta Huang ◽

George Kuo

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Meta Analysis ◽

Stress Test ◽

Kidney Injury ◽

Predictive Marker ◽

Systemic Review ◽

Injury Progression

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Safety of Argatroban in critically ill patients with acute kidney injury and renal replacement therapy after cardiac surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269141 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

M Klingele ◽

A Lerner-Gräber ◽

D Fliser ◽

HJ Schäfers ◽

H Groesdonk

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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

The Heart Surgery Forum ◽

10.1532/hsf.1577 ◽

2016 ◽

Vol 19 (3) ◽

pp. 123 ◽

Cited By ~ 7

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

Background: 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). Methods: 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 <3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL. Results: 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; 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. Conclusion: Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

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