Determinants of urinary output response to IV furosemide in acute kidney injury

Silbert, Benjamin I., Ho, Kwok M., Lipman, Jeffrey, Roberts, Jason A., Corcoran, Tomas B., Morgan, David J., Pavey, Warren, Mas, Emilie, Barden, Anne E., & Mori, Trevor A. (2016) Determinants of urinary output response to IV furosemide in acute kidney injury. Critical Care Medicine. (In Press)

View at publisher

Abstract

OBJECTIVES

  • This study assessed the determinants of urinary output response to furosemide in acute kidney injury; specifically, whether the response is related to altered pharmacokinetics or pharmacodynamics.

DESIGN

  • Prospective cohort.

SETTING

  • Tertiary ICU.

PATIENTS

  • Thirty critically ill patients with acute kidney injury without preexisting renal impairment or recent diuretic exposure.

INTERVENTION

  • A single dose of IV furosemide.

MEASUREMENTS AND MAIN RESULTS

  • Baseline markers of intravascular volume status were obtained prior to administering furosemide. Six-hour creatinine clearance, hourly plasma/urinary furosemide concentrations, and hourly urinary output were used to assess furosemide pharmacokinetics/pharmacodynamics parameters. Of 30 patients enrolled, 11 had stage-1 (37%), nine had stage-2 (30%), and 10 had stage-3 (33%) Acute Kidney Injury Network acute kidney injury. Seventy-three percent were septic, 47% required norepinephrine, and 53% were mechanically ventilated. Urinary output doubled in 20 patients (67%) following IV furosemide. Measured creatinine clearance was strongly associated with the amount of urinary furosemide excreted and was the only reliable predictor of the urinary output after furosemide (area under the receiver-operating-characteristic curve, 0.75; 95% CI, 0.57-0.93). In addition to an altered pharmacokinetics (p < 0.01), a reduced pharmacodynamics response to furosemide also became important when creatinine clearance was reduced to less than 40 mL/min/1.73 m (p = 0.01). Acute kidney injury staging and markers of intravascular volume, including central venous pressure, brain-natriuretic-peptide concentration, and fractional urinary sodium excretion were not predictive of urinary output response to furosemide.

CONCLUSIONS

  • The severity of acute kidney injury, as reflected by the measured creatinine clearance, alters both pharmacokinetics and pharmacodynamics of furosemide in acute kidney injury, and was the only reliable predictor of the urinary output response to furosemide in acute kidney injury.

Impact and interest:

0 citations in Scopus
Search Google Scholar™

Citation counts are sourced monthly from Scopus and Web of Science® citation databases.

These databases contain citations from different subsets of available publications and different time periods and thus the citation count from each is usually different. Some works are not in either database and no count is displayed. Scopus includes citations from articles published in 1996 onwards, and Web of Science® generally from 1980 onwards.

Citations counts from the Google Scholar™ indexing service can be viewed at the linked Google Scholar™ search.

ID Code: 95725
Item Type: Journal Article
Refereed: Yes
DOI: 10.1097/CCM.0000000000001823
ISSN: 0090-3493
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Copyright Owner: 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
Deposited On: 24 May 2016 00:44
Last Modified: 25 May 2016 21:58

Export: EndNote | Dublin Core | BibTeX

Repository Staff Only: item control page