Currently, continuous renal replacement therapy (CRRT) is the main modality for renal support in critically ill patients with hemodynamic instability. Most studies have investigated the timing of RRT initiation. However, prolonged CRRT demonstrated the association of many unexpected events, such as catheter-related complications, catheter-related blood stream infection, hypotension, hypothermia, tachycardia, and atrial fibrillation. Up to now, there is a lack of evidence regarding the timing of withholding CRRT. The furosemide stress test (FST) is a tool that is easy to use and has more availability. The investigators aimed to apply FST to evaluate renal recovery compared with standard treatment in critically ill patients undergoing CRRT.
Adult 20 year of age or older
Acute kidney injury (AKI) stage 3 according to Kidney Disease Improving Global Outcomes (KDIGO) classification with oliguria (urine <400 ml/day)
Initiate CRRT in ICU (medical ICU, surgical ICU, cardiac care unit) for at least 48 hours (time for initiation and modality of CRRT can adjust by clinician)
Use any inotropic drug (norepinephrine, epinephrine, dopamine, dobutamine)
Blood urea nitrogen (BUN) >80 mg/dL
Serum K <3.5 or >5 mmol/L
Arterial potential of Hydrogen (pH) <7.3
Parallel
Furosemide Injection
DrugAfter taking furosemide at 1.5 mg/kg intravenously, if the urine output exceeds 200 mL within 2 hours, the patients are going to withhold CRRT. But if there is no response, the titration of furosemide to 2.5 mg/kg and 3.5 mg/kg every 6 hours is scheduled according to the urine output \>200 mL in 2 hours (not exceeding 250 mg).
% of patients with Renal recovery
Free of RRT for at least 5 days
% of patients with Mortality
28 days all cause mortality and in-hospital mortality
RRT free days
No need to restart RRT
Day of Hospitalization
Length of hospital stay and ICU stay
Ventilator-free day
Number of mechanical ventilator-free day
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