Haley Fox
Froedtert and the Medical College of Wisconsin Froedtert Hospital
Milwaukee
Disclosure information not submitted.
Jacob DeCleene, PharmD, BCCCP
Clinical Pharmacist
University of Iowa Hospitals and Clinics, United States
Disclosure information not submitted.
Title: Relationship between mean arterial pressure and furosemide stress test success rates
Introduction: Acute kidney injury is a common occurrence in critically ill patients that is associated with significant morbidity and mortality. Furosemide is a loop diuretic that, because of its pharmacologic action, can be used to assess the functional integrity of the renal tubules. The furosemide stress test (FST) is the administration of intravenous (IV) high-dose furosemide and its success is determined by measuring the urine output produced in the two-hour period following the administration. While the FST is a low-cost, safe, and easy assessment of renal tubular function, other factors such as mean arterial pressure (MAP), which may influence the success rates of the FST, are not well defined. This study sought to evaluate the relationship between MAP and success rates of the FST critically ill patients.
Methods: Retrospective, single-center cohort study. ICUs in a tertiary medical center, between September 01, 2016 and July 31, 2020. Critically ill adult patients given at least one dose of IV furosemide (≥ 1 – 1.5 mg/kg) were included. The primary outcome was whether a MAP ≥ 75 mmHg would equate to a higher FST success rate. The secondary outcome was the success rate of patients on one or more vasopressors. Categorical data were analyzed using the chi-square test or Fischer’s exact test. Continuous data were analyzed using the Student’s t-test and a logistic regression test.
Results and
Conclusions: Of 225 patients, 88 (39.1%) had a successful FST. In patients with a MAP ≥ 75 mmHg, 60 out of 104 (57.7%) had a successful FST compared to 28 out of 121 (23.1%) of patients who had a MAP < 75 mmHg (p < 0.0001). Patients on vasopressors at the time of the furosemide dose had lower rates of success compared to those not on vasoactive agents (30.4% vs 68.2%, p = 0.026). Of 92 patients requiring vasopressors, 11 out of 20 (55.0%) patients with a MAP ≥ 75 mmHg had a successful FST compared to 17 out of 72 (23.6%) with a MAP < 75 mmHg (p = 0.0070). In conclusion, patients with a MAP ≥ 75 mmHg were significantly more likely to have a successful FST compared to those with a MAP < 75 mmHg.