Predicting Worsening Acute Kidney Injury With a Water-Pill (Furosemide) Test and Blood Markers in Patients With Low Albumin

Maithe Caroline Inacio

Status: Completed

Conditions: Hypoalbuminemia; Acute Kidney Injury

Treatments: Diagnostic Test: Serum Biomarkers and NGAL; Diagnostic Test: Furosemide Stress Test

Study type: Interventional

Funder types: Other

Identifiers

NCT07688733

NF22-00003

U1111-1342-1576 (Other Identifier)

Details and patient eligibility

About

The goal of this clinical trial is to learn if serum biomarkers can better predict worsening of acute kidney injury (AKI) compared to the Furosemide Stress Test (FST) in adult patients with low albumin levels (hypoalbuminemia) admitted to an intensive care unit (ICU). The main questions it aims to answer are:

Can serum biomarkers predict progression to severe AKI (stage 3) better than the Furosemide Stress Test in patients with low albumin levels? Is there a relationship between serum biomarkers levels and serum albumin levels in these patients?

Researchers will compare serum biomarkers levels and FST results to see which test more accurately identifies patients at risk of developing severe AKI.

Participants will:

Provide a sample for serum biomarkers measurement at study entry Receive a single intravenous dose of furosemide (a diuretic medication) to assess kidney function Have their urine output monitored for 6 hours after the furosemide dose Be followed for 15 days to track kidney function, need for dialysis, and survival

Enrollment: 55 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 years or older
• Serum albumin < 3 g/dL (hypoalbuminemia)
• AKI diagnosed per KDIGO 2012 criteria, stage 1 or 2
• Adequate fluid resuscitation at discretion of treating nephrologist
• Cellular casts in urinary sediment (George Washington Urine Sediment Score > 2) or fractional excretion of sodium (FENa) > 1%
• Foley catheter in place
• Written informed consent obtained

Exclusion criteria

• Age under 18 years
• Pregnancy
• Obstructive urinary pathology
• Active bleeding
• Allergy or hypersensitivity to loop diuretics
• AKI stage 3 (KDIGO) at enrollment
• Inadequate fluid resuscitation prior to the stress test
• Known chronic kidney disease with eGFR < 30 mL/min/1.73 m² (CKD-EPI equation)

Trial design

Primary purpose: Diagnostic

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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55 participants in 1 patient group

AKI with Hypoalbuminemia

Experimental group

Description:

Adult ICU patients with KDIGO stage 1-2 AKI and serum albumin \<3 g/dL. All participants underwent urinary NGAL measurement followed by a standardized Furosemide Stress Test (furosemide 1-1.5 mg/kg IV). Outcomes assessed over 15 days: progression to KDIGO stage 3, need for renal replacement therapy, and mortality.

Treatment:

Diagnostic Test: Furosemide Stress Test

Diagnostic Test: Serum Biomarkers and NGAL