Response to frusemide in critically ill patients requiring dialysis
Frusemide stress test responsiveness in critically ill patients requiring continuous renal replacement therapy patients (FST-CRRT): a feasibility study
St Vincent's Hospital, Melbourne
40 participants
Dec 11, 2024
Interventional
Conditions
Summary
The administration of furosemide (a diuretic drug designed to increase production of urine) has been shown to predict a critically ill patient's requirement for dialysis (CRRT). This has been termed the frusemide stress test (FST). Critically ill patients often require dialysis in ICU for severe injury to the kidneys. There is a large amount of evidence around when to start, however there is little to guide clinicians on when the optimal time to stop dialysis is. This is important as whilst dialysis may be life saving, once the kidneys have started to recover it can result in harm. We aim to seek the proportion of patients who respond to the FST and identify whether a future randomised trial to aid clinicians in stopping dialysis at an appropriate time is feasible.
Eligibility
Inclusion Criteria14
- Patients admitted to ICU
- Age greater than or equal to 18 years
- Severe Acute Kidney Injury (AKI) requiring CRRT or < 12 hours since CRRT paused
- CRRT duration greater than 24 hours
- Metabolic stability (defined as pH greater than 7.35, Potassium less than 5.5 mmol/L, Urea less than 30 mmol/L)
- Euvolaemia and stable/improving haemodynamic requirements as determined by clinical assessment and hemodynamic measurements
- Urine Output of at least 10mls per hour in the preceding 3 hours (total of 30mls/3hours)
- History of end-stage renal failure with prior dialysis
- Non-renal indication for ongoing CRRT e.g. toxin
- Death or withdrawal of active treatment while on CRRT
- Planned transfer to another acute hospital within 7 days
- Clinician assessment that study is not in patient’s best interest
- Pregnancy or Breastfeeding
- Urine output greater than 50mls per hour for 3 or more hours (total 150mls/3 hours)
Exclusion Criteria1
- Known anaphylaxis or severe allergy to frusemide
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Interventions
The administration of a single dose of intravenous frusemide will be administered at 1mg/kg (or 1.5mg/kg if received frusemide in the past seven days). The intervention will be administered as soon as practically possible once all inclusion criteria are met and with agreement from the treating intensivist. Medication charts will be reviewed to confirm administration.
Locations(2)
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ACTRN12625001227482