Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children

Katja M Gist; Jamie Penk; Eric L Wald; Laura Kitzmiller; Tennille N Webb; Kelli Krallman; John Brinton; Danielle E Soranno; Stuart L Goldstein; Rajit K Basu

doi:10.1055/s-0041-1732447

Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children

J Pediatr Intensive Care. 2021 Jul 29;12(4):289-295. doi: 10.1055/s-0041-1732447. eCollection 2023 Dec.

Authors

Affiliations

¹ Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States.
² Department of Pediatrics, Division of Pediatric Critical Care, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, United States.
³ Pediatric Critical Care, Department of Pediatrics, Essentia Health St Mary's Medical Center, Duluth, Minnesota, United States.
⁴ Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama, United States.
⁵ Section of Pediatric Critical Care Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, United States.
⁶ Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States.
⁷ Department of Pediatrics, Division of Pediatric Nephrology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States.
⁸ Department of Pediatrics, University of Cincinnati, Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, United States.
⁹ Department of Pediatrics, Division of Critical Care Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, United States.

Abstract

A standardized, quantified assessment of furosemide responsiveness predicts acute kidney injury (AKI) in children after cardiac surgery and AKI progression in critically ill adults. The purpose of this study was to determine if response to furosemide is predictive of severe AKI in critically ill children outside of cardiac surgery. We performed a multicenter retrospective study of critically ill children. Quantification of furosemide response was based on urine flow rate (normalized for weight) measurement 0 to 6 hours after the dose. The primary outcome was presence of creatinine defined severe AKI (Kidney Disease Improving Global Outcomes stage 2 or greater) within 7 days of furosemide administration. Secondary outcomes included mortality, duration of mechanical ventilation and length of stay. A total of 110 patients were analyzed. Severe AKI occurred in 20% ( n = 22). Both 2- and 6-hour urine flow rate were significantly lower in those with severe AKI compared with no AKI ( p = 0.002 and p < 0.001). Cutoffs for 2- and 6-hour urine flow rate for prediction of severe AKI were <4 and <3 mL/kg/hour, respectively. The adjusted odds of developing severe AKI for 2-hour urine flow rate of <4 mL/kg/hour was 4.3 (95% confidence interval [CI]: 1.33-14.15; p = 0.02). The adjusted odds of developing severe AKI for 6-hour urine flow rate of <3 mL/kg/hour was 6.19 (95% CI: 1.85-20.70; p = 0.003). Urine flow rate in response to furosemide is predictive of severe AKI in critically ill children. A prospective assessment of urine flow rate in response to furosemide for predicting subsequent severe AKI is warranted.

Keywords: acute kidney injury; critically ill; furosemide; pediatrics; urine flow rate.

Grants and funding

Funding J.B. disclosed that a portion of his FTE is supported by the Children's Hospital Colorado Research Institute and Pediatric Kidney Injury and Disease Stewardship Program to help with analyses and manuscript preparation. D.E.S. is funded by an NIH K08 Career development award.