Furosemide Stress Test for the Prediction of Acute Kidney Injury Severity in Acute Heart Failure Patients

Study Overview
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Brief Summary
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This study is aim to study the changes of serum creatinine levels at 72 hours after admission in patients with acute heart failure who has diuretic resistance compared to those who do not have diuretic resistance from furosemide stress test

Detailed Description
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This study is an observational prospective study to demonstrate a prognosis of acute heart failure patients who have diuretic resistance compared to those who do not have diuretic resistance from furosemide stress test. The primary outcome is changes of serum creatinine levels at 72 hours compared to baseline values at the time of admission.

Official Title
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Furosemide Stress Test for the Prediction of Acute Kidney Injury Severity in Acute Heart Failure Patients

Conditions
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Heart Failure, Acute Kidney Injury

Intervention / Treatment
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* Diagnostic Test: Furosemide stress test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥18 years Diagnosis of acute heart failure which is defined by 2 of the 3 following features: ≥2+ leg edema, jugular venous pressure >10 cm from physical examination or central venous pressure >10 mmHg, and bilateral pulmonary edema or bilateral pleural effusion from chest radiography Patients consent to participate into the study Exclusion Criteria: Patients who receive furosemide ≥500 mg/day or hydrochlorothiazide ≥100 mg/day or spironolactone ≥100 mg/day or tolvaptan of any doses Patients who have systolic blood pressure <100 mmHg or who need vasoactive drugs inotropic agents (except dobutamine) Patients with intravascular volume depletion from clinical evaluation Patients with chronic kidney disease stage 5 (estimated glomerular filtration rate <15 ml/min/1.73 m2) or patients who receive maintenance dialysis Patients who require renal replacement therapy at the time of admission Patients whom diagnosed hypertrophic obstructive cardiomyopathy, severe valvular stenosis or complex congenital heart disease Patients with sepsis or systemic infection Pregnant women Patients who have history of furosemide, spironolactone or hydrochlorothiazide allergy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Heart failure with diuretic resistance<br>This group includes acute heart failure patients who has diuretic resistance from furosemide stress test. Furosemide stress test will be performed by administration of intravenous furosemide 1 mg/kg in patients who do not receive oral furosemide before and 1.5 mg/kg patients who have received oral furosemide before. Diuretic resistance was defined as urine output <250 hr at 2 hours after furosemide administration. | Diagnostic Test: Furosemide stress test<br>* Furosemide stress test is performed by administration of intravenous furosemide 1 mg/kg in patients who do not receive oral furosemide before and 1.5 mg/kg patients who have never received oral furosemide.<br>|
| Heart failure without diuretic resistance<br>This group includes acute heart failure patients who do not have diuretic resistance from furosemide stress test. Furosemide stress test will be performed by administration of intravenous furosemide 1 mg/kg in patients who do not receive oral furosemide before and 1.5 mg/kg patients who have never received oral furosemide before. Patients will be defined not to have diuretic resistance if their urine output ≥250 hr at 2 hours after furosemide administration. | Diagnostic Test: Furosemide stress test<br>* Furosemide stress test is performed by administration of intravenous furosemide 1 mg/kg in patients who do not receive oral furosemide before and 1.5 mg/kg patients who have never received oral furosemide.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum creatinine | Changes in serum creatinine from baseline | Seventy-two hours after admission | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum creatinine | Changes in serum creatinine from baseline | Day 7 of hospital admission | 
| Requirement for renal replacement therapy | Renal replacement therapy is defined as any mode of dialysis or extracorporeal therapy to treat volume overload for heart failure | During hospital admission period | 
| Length of hospital admission | Numbers of days that patients need to stay in the hospital | During hospital admission period | 
| Changes of the stage of heart failure defined by New York Heart Association (NYHA) classification | Heart failure stage defined by New York Heart Association (NYHA) classification | Day 7 and 28 after hospital admission | 
| Numbers of hospital readmission | Readmission to the hospital due to heart failure | Month 1 and 3 after hospital discharge | 
| Mortality rate | Confirmed death | Day 7 and 28 after hospital admission |