Factors affecting response to furosemide stress test among critically ill hypoalbuminemic patients with AKI without prior albumin infusion

TL;DR

The study finds that many critically ill patients with low albumin and kidney injury can still respond to a furosemide stress test without needing albumin first.

Contribution

It shows that furosemide stress tests can be effective in hypoalbuminemic AKI patients without prior albumin infusion.

Findings

80.5% of hypoalbuminemic AKI patients responded to furosemide stress test without prior albumin.

Lower baseline albumin levels were linked to non-response to the test.

Furosemide stress test remains useful in hypoalbuminemic AKI patients despite low albumin.

Abstract

Acute kidney injury (AKI) is a common and serious condition often associated with hypoalbuminemia, which can influence the pharmacokinetics and efficacy of diuretics like furosemide. In critically ill patients, sepsis is the major cause of AKI, accounting for nearly 50% of cases.

To evaluate whether AKI patients with hypoalbuminemia can respond to FST without albumin supplementation.

This is a prospective quasi-experimental study. Patients were obtained from the intensive care unit of Cairo University Hospital with AKI stages 1 and 2 with hypoalbuminemia. A bolus of furosemide was administered at a dose calculated to be 1-1.5 mg/kg in a single dose to patients without a prior diagnosis of kidney disease and clinical signs of hypovolemia.

A total of 41 critically ill patients with AKI were enrolled, aged between 18 and 80 years, of whom 56.10% had diabetes mellitus, 53.70% were on at least one nephrotoxic medication, and 56.10% had sepsis as the cause of AKI. The median (IQR) albumin level was 1.9 g/dL (1.4–2.7). Among 41 hypoalbuminemic AKI patients included, 80.50% responded to FST without prior albumin infusion. Non-responders had significantly lower baseline serum albumin levels, median (IQR) 1(1–2) vs. 2 (1–3) g/dL, p < 0.002).

AKI patients with mild-to-moderate hypoalbuminemia may still respond to FST without albumin infusion, although response rates decline with the increasing severity of hypoalbuminemia. The FST remains a valuable predictive tool in hypoalbuminemic AKI patients but warrants further investigation to optimize its utility in this population.

Not applicable.

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