Furosemide Stress Test to Predict Successful Liberation From RRT

Study Overview
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Brief Summary
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The proposed study will evaluate if a standardised dose of furosemide administered in the 12 hours after RRT liberation can predict successful liberation in critically ill patients. The dose that will be administered is in accordance with the prescribing information.

Detailed Description
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Response to furosemide administration is commonly used in clinical practice to assess a patient's potential for RRT liberation. However, this administration is not standardized and practices varies greatly. Rapid recognition of unsuccessful RRT liberation is crucial to avoid further complications such as fluid overload or acid-base and electrolyte disorders. The FST corresponds to the intravenous administration of 1 mg/kg (1.5 mg/kg in previously exposed patients) of furosemide and the assessment of resulting diuresis in the following two hours. FST is able to predict progression from AKI stage I and II to stage III with a high sensitivity (87.1%) and specificity (84.1%), area under the ROC curve 0.87. However, the ability of FST to predict RRT liberation has never been formally assessed.

Official Title
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Evaluation of the Furosemide Stress Test to Predict Successful Liberation From Renal Replacement Therapy in Critically Ill Patients

Conditions
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Acute Kidney Injury

Intervention / Treatment
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* Drug: Furosemide stress test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Receiving continuous RRT for AKI Having an indwelling urinary catheter Clinical decision by physician in charge to attempt RRT liberation (first attempt) lnformed consent signed by the patient himself / legal representative or authorization received from independent physician Exclusion Criteria: Electrolyte disturbances or hemodynamic instability precluding the use of furosemide (sodium > 155 mmol/L and/or potassium < 3.0 mmol/L and/or metabolic alkalosis > 7.50 and/or mean arterial pressure < 60 mmHg) Known furosemide allergy Urine output ≥ 100 mL/h for at least two hours Recent (< 24 hours) FST Known end-stage chronic renal disease at ICU admission Withdrawal of life support decision taken before inclusion Patient already participating in conflicting research study Any other contraindication of furosemide

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 |
| --- | --- |
| Critically ill patients undergoing RRT<br>Patients admitted to participating ICU and receiving renal replacement therapy. | Drug: Furosemide stress test<br>* The FST corresponds to the intravenous single-dose administration of 1 mg/kg (1.5 mg/kg in previously exposed patients) of furosemide and the assessment of resulting diuresis in the following two hours. In the 12 hours following the first RRT liberation, a FST will be performed. The test will be considered positive if urinary output is ≥200 mL in the two hours following furosemide administration.<br>* Other names: FST;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful liberation of RRT within 72 hours after FST | No renal replacement therapy administered | within 72 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful liberation of RRT at ICU discharge | No renal replacement therapy administered | At time of ICU discharge, assessed up to 90 days post inclusion | 
| Successful liberation of RRT at hospital discharge | No renal replacement therapy administered | At time of hospital discharge, assessed up to 90 days post inclusion | 
| Adverse events associated with the intervention | (electrolyte disturbances, hypotension) | within 6 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Renal replacement therapy, Acute Kidney Injury, Furosemide Stress Test