Evidence map›Paper›PMID 29673370›Full record

Trial reportCritical care (London, England)2018

Early versus standard initiation of renal replacement therapy in furosemide stress test non-responsive acute kidney injury patients (the FST trial).

Nuttha Lumlertgul, Sadudee Peerapornratana, Thananda Trakarnvanich, Wanjak Pongsittisak, Kajbundit Surasit, Anan Chuasuwan, Pleumjit Tankee, Khajohn Tiranathanagul, Kearkiat Praditpornsilpa, Kriang Tungsanga and 4 more

2 registry-linked trialsOpen access · goldAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 72 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
72citing papers in PubMed, 15 pooled it
11.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02730117 nacompletednot on this map

Does Early Initiation of Renal Replacement Therapy Have an Impact on 7-day Fluid Balance in Critically Ill Patients With Acute Kidney Injury With Positive Furosemide Stress Test?: a Multicenter Randomized Controlled Trial

TypeinterventionalSponsorChulalongkorn UniversityRan2016 to 2017Enrolled118ConditionsAcute Kidney InjuryArmsDialysis with continuous renal replacement therapy, Mechanical ventilator, Anti-Bacterial Agents, Vasopressors
NCT06229990 phase4recruitingnot on this mapstarted 2024, after this paper: background citation

Effect of a Furosemide Stress Test-Guided Strategy on Liberation From Continuous Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury (FST-LIBERATE)

TypeinterventionalSponsorChiang Mai UniversityRan2024 to 2028Enrolled80ConditionsAcute Kidney InjuryArmsFurosemide Injection
3 · Its place in the literature

Who cites it

72 citing papers in PubMed, 15 syntheses or guidelines pooled it, 166 citations in OpenAlex.

  1. Pooled it
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  4. Diuretics for preventing and treating acute kidney injury.The Cochrane database of systematic reviews · 2025
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  6. Timing of kidney replacement therapy initiation for acute kidney injury.The Cochrane database of systematic reviews · 2022
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  12. Guideline
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  18. Kidney Failure in Cardiogenic Shock.Circulation. Heart failure · 2026
    Review
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12 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 2 countries.

Nuttha LumlertgulDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Sadudee PeerapornratanaDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Thananda TrakarnvanichRenal Division, Department of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Wanjak PongsittisakRenal Division, Department of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Kajbundit SurasitNakhon Ping Hospital, Chiang Mai, Thailand.
Anan ChuasuwanBhumibol Adulyadej Hospital, Bangkok, Thailand.
Pleumjit TankeeVajira Phuket Hospital, Phuket, Thailand.
Khajohn TiranathanagulDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Kearkiat PraditpornsilpaDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Kriang TungsangaDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Somchai Eiam-OngDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
John A KellumThe Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Nattachai SrisawatDivision of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. drnattachai@yahoo.com.
FST Study Group
Chulalongkorn University · THNavamindradhiraj University · THBhumibol Adulyadej Hospital · THUniversity of Pittsburgh · USVachira Phuket Hospital · TH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe timing of initiation of renal replacement therapy (RRT) in severe acute kidney injury (AKI) remains controversial, with early initiation resulting in unnecessary therapy for some patients while expectant therapy may delay RRT for other patients. The furosemide stress test (FST) has been shown to predict the need for RRT and therefore could be used to exclude low-risk patients from enrollment in trials of RRT timing. We conducted this multicenter pilot study to determine whether FST could be used to screen patients at high risk for RRT and to determine the feasibility of incorporating FST into a trial of early initiation of RRT.

methodsFST was performed using intravenous furosemide (1 mg/kg in furosemide-naive patients or 1.5 mg/kg in previous furosemide users). FST-nonresponsive patients (urine output less than 200 mL in 2 h) were then randomized to early (initiation within 6 h) or standard (initiation by urgent indication) RRT.

resultsFST was completed in all patients (100%). Only 6/44 (13.6%) FST-responsive patients ultimately received RRT while 47/60 (78.3%) nonresponders randomized to standard RRT either received RRT or died (P <  0.001). Among 118 FST-nonresponsive patients, 98.3% in the early RRT arm and 75% in the standard RRT arm received RRT. The adherence to the protocol was 94.8% and 100% in the early and standard RRT group, respectively. We observed no differences in 28-day mortality (62.1 versus 58.3%, P = 0.68), 7-day fluid balance, or RRT dependence at day 28. However, hypophosphatemia occurred more frequently in the early RRT arm (P = 0.002).

conclusionThe furosemide stress test appears to be feasible and effective in identifying patients for randomization to different RRT initiation times. Our findings should guide implementation of large-scale randomized controlled trials for the timing of RRT initiation.

trial registrationclinicaltrials.gov, NCT02730117 . Registered 6 April 2016.

Indexed as

Time FactorsAcute Kidney InjuryAgedAged, 80 and overAnalysis of VarianceAPACHEChi-Square DistributionExercise TestFemaleFurosemideHumansMaleMiddle AgedOrgan Dysfunction ScoresPredictive Value of TestsProportional Hazards ModelsFurosemideAcute kidney injuryFurosemide stress testRenal replacement therapy

Identifiers

PMID29673370
PMCPMC5909278
OpenAlexW2800727100

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.