P1728furosemide Stress Test Predicts Discharge Serum Creatinine After Kidney Transplantation

Abstract

Background and Aims Acute tubular necrosis is a common complication after kidney transplantation and is closely related to delayed graft function (DGF) and slower graft function recovery after surgery. The furosemide stress test (FST) uses a standardized dose of furosemide to evaluate the integrity of the renal tubule and determine which patients have developed severe tubular damage. We aimed to apply the FST to a sample of incident deceased-donor kidney transplant recipients and describe its association with DGF and serum creatinine (SCr) at discharge. Method Single-center prospective observational study of deceased-donor kidney transplant recipients. The FST, a standardized bolus dose of furosemide (1.5 mg/kg) was administered between the 3rd and 5th day after surgery. Patients were excluded if, during that time period, they presented evidence of active bleeding, obstructive uropathy or volume depletion. Urine output (UO) 60 and 120 min after FST was registered. To reduce the risk of hypovolemia, each ml of UO produced for six hours after FST was replaced with 1 ml of normal saline. Results 25 patients were included in the study. Mean 2h FST UO was 1012±570 ml. Demographic and clinical data are summarized in Table 1. Subjects that suffered DGF had a significantly lower 2h FST UO (534 vs 1164 ml; P=0.015). In adjusted linear regression analysis only a 2h FST UO<1000 ml (β=0.906; 95%CI: 0.04-1.772; P=0.041) and DGF (β=1.592; 95%CI: 0.488-2.696; P=0.008) were independent predictors of SCr at discharge (model adjusted for recipient age, cold ischemia time, number of HLA mismatches, donor SCr and donor hypertension). Conclusion Recipients with a 2h FST UO <1000 ml suffered DGF more frequently. FST and DGF were independent predictors of SCr at discharge. A standardized FST could help clinicians distinguish patients with more severe tubular dysfunction and higher risk of DGF.