Ankit Sakhuja1, Ghassan Bandak2, Erin F Barreto3, Saraschandra Vallabhajosyula4, Jacob Jentzer5, Robert Albright6, Kianoush B Kashani7. 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. Electronic address: asakhuja@alumni.mcw.edu. 2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN. 3. Department of Pharmacy, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. 4. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. 5. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. 6. Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN. 7. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN.
Abstract
OBJECTIVE: To assess whether loop diuretic challenge predicts the need for dialysis among critically ill patients with acute kidney injury (AKI) stage 3. PATIENTS AND METHODS: Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours. RESULTS: Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively. CONCLUSION: Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.
OBJECTIVE: To assess whether loop diuretic challenge predicts the need for dialysis among critically illpatients with acute kidney injury (AKI) stage 3. PATIENTS AND METHODS: Adult patients admitted to intensive care units between January 1, 2004, and December 31, 2016, were screened. Acute kidney injury stage 3 was identified by an electronic surveillance tool, and patients who received loop diuretics in a dosage of at least 1mg/kg intravenous bolus furosemide equivalent were included. Urine output following loop diuretic challenge was modeled as a restricted cubic spline. We then compared the area under the receiver operating characteristic curve for urine outputs at 2 hours and 6 hours after loop diuretic challenge to predict the need for dialysis within the next 24 hours. RESULTS: Of 687 patients included in the study, those who received dialysis were younger and had higher Sequential Organ Failure Assessment scores on the day of loop diuretic challenge. Urine outputs at 2 hours and 6 hours were lower in patients who needed dialysis, but urine output by 6 hours was better in predicting dialysis initiation within 24 hours (area under the curve, 0.71 vs 0.67; P=.02). The sensitivity and specificity of 6-hour urine output cutoff of 600 mL or less to predict dialysis was 80.9% and 50.5%, respectively, and that for 300 mL or less was 64.2% and 68.2%, respectively. CONCLUSION: Among patients with stage 3 AKI, 6-hour urine output after the loop diuretic challenge had a modest discriminant capacity to identify dialysis initiation within the next 24 hours.
Authors: Jay L Koyner; Danielle L Davison; Ermira Brasha-Mitchell; Divya M Chalikonda; John M Arthur; Andrew D Shaw; James A Tumlin; Sharon A Trevino; Michael R Bennett; Paul L Kimmel; Michael G Seneff; Lakhmir S Chawla Journal: J Am Soc Nephrol Date: 2015-02-05 Impact factor: 10.121
Authors: Blaithin A McMahon; Jay L Koyner; Tessa Novick; Steve Menez; Robert A Moran; Bonnie E Lonze; Niraj Desai; Sami Alasfar; Marvin Borja; William T Merritt; Promise Ariyo; Lakhmir S Chawla; Edward Kraus Journal: Biomarkers Date: 2017-10-16 Impact factor: 2.658
Authors: Balwinder Singh; Amandeep Singh; Adil Ahmed; Gregory A Wilson; Brian W Pickering; Vitaly Herasevich; Ognjen Gajic; Guangxi Li Journal: Mayo Clin Proc Date: 2012-09 Impact factor: 7.616
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: Saraschandra Vallabhajosyula; Shannon M Dunlay; Gregory W Barsness; Saarwaani Vallabhajosyula; Shashaank Vallabhajosyula; Pranathi R Sundaragiri; Bernard J Gersh; Allan S Jaffe; Kianoush Kashani Journal: PLoS One Date: 2019-09-18 Impact factor: 3.240
Authors: Armando Coca; Carmen Aller; Jimmy Reinaldo Sánchez; Ana Lucía Valencia; Elena Bustamante-Munguira; Juan Bustamante-Munguira Journal: Int J Mol Sci Date: 2020-04-27 Impact factor: 5.923