The furosemide stress test predicts successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Purpose: There is still no good method for predicting renal recovery and successful discontinuation of continuous renal replacement therapy (CRRT). This study assessed the ability of the furosemide stress test (FST) to predict successful discontinuation of CRRT. Materials and methods: This prospective single-center study included patients with acute kidney injury who underwent an initial attempt at discontinuation of CRRT. Successful discontinuation was defined as alive without renal replacement therapy for 7 days after discontinuation. Furosemide 1.0 mg/kg was administered intravenously within 2 h after discontinuation of CRRT. Urine output was recorded for the next 2 h. Receiver-operating characteristic curve and logistic regression analyses were performed to determine the best discriminative variable and to identify independent risk factors. Results: Discontinuation of CRRT was successful in 30 of 55 patients. The area under the curve for prediction of successful discontinuation was significantly greater for urine output in the 2 h following the FST (0.913) than for 24-h urine output on the previous day (0.739, P = 0.003) and urine neutrophil gelatinase-associated lipocalin (0.725, P = 0.020). A 2-h urine output of 188 mL had optimal sensitivity (0.800) and specificity (0.920). Multivariate analysis showed that 2-h urine output independently predicted successful discontinuation. Conclusions: A urine output >188 mL in the first 2 h after FST predicted successful discontinuation of CRRT.