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Urine volume as a predicting factor for furosemide clearance during continuous infusion in AKI septic shock patients on hemodiafiltration

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Abstract

Background

This study assessed the contribution of intracorporeal (IC) and extracorporeal clearance (EC) of furosemide in patients with septic acute kidney injury (AKI), and the relationship between plasma concentrations and urine volume.

Methods

Prospective cohort observational study of 15 patients with septic AKI undergoing continuous veno-venous hemodiafiltration (CVVHDF) divided according to urine volume (< 500 ml/12 h, Oliguria group, n = 5; > 500 ml/12 h, Diuresis group, n = 10) during continuous infusion of furosemide (120 mg/12 h) at steady-state condition. Plasma and effluent furosemide concentrations were determined by high-performance liquid chromatography (HPLC)-mass spectrometry every 12 h for 48 h.

Results

Furosemide plasma concentrations and total body clearance (TBC) were 6.14 mg/l and 22.1 ml/min for the Oliguria group, and 2.63 mg/l and 54.4 ml/min for the Diuresis group, respectively (p < 0.05). When urine volume was < 500 ml/24 h, the furosemide plasma concentrations peaked at the potentially toxic value of 13.0 mg/l. Furosemide EC was not relevant for the Diuresis group, but it represented 18% of TBC for the Oliguria group. Furosemide plasma concentrations correlated positively with dose infusion for both groups (r = 0.728 and 0.685, p < 0.05), and negatively with urine volume only for the Diuresis (r = − 0.578, p < 0.01) but not for the Oliguria group (r = − 0.089, p = 0.715).

Conclusions

For patients with urine volume > 500 ml/12 h continuous infusion of furosemide up to 480 mg/24 h leads to increasing urine volume, which can predict furosemide plasma levels within its safety range. When the urine volume is lower, the furosemide plasma levels are increased beyond any further diuretic efficacy.

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Abbreviations

AKI:

Acute kidney injury

TBC:

Total body clearance

EC:

Extracorporeal clearance

IC:

Intracorporeal clearance

KDIGO:

Kidney Disease Improving Global Outcomes

BCrC:

Blood creatinine clearance

CRRT:

Continuous renal replacement therapy

CVVHDF:

Continuous veno-venous hemodiafiltration

ACN:

Acetonitrile

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Funding

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Authors and Affiliations

  1. Nephrology, Dialysis and Transplantation Unit, Department of Medical Sciences, City of Health and Science, CTO Hospital, University of Turin, Via G. Zuretti 29, 10126, Turin, Italy

    Filippo Mariano & Luigi Biancone

  2. Regional Antidoping and Toxicology Center “Alessandro Bertinaria”, Orbassano, Turin, Italy

    Marta Leporati & Marco Vincenti

  3. Anesthesia and Intensive Care 3, Department of Anesthesia and Intensive Care, City of Health and Science, CTO Hospital, Turin, Italy

    Paola Carignano

  4. Plastic Surgery and Major Burns, Department of General and Specialized Surgery, City of Health and Science, CTO Hospital, Turin, Italy

    Maurizio Stella

  5. Department of Chemistry, University of Turin, Turin, Italy

    Marco Vincenti

Authors
  1. Filippo Mariano
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  2. Marta Leporati
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  3. Paola Carignano
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  4. Maurizio Stella
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  5. Marco Vincenti
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  6. Luigi Biancone
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Correspondence to Filippo Mariano.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals who participated in the study.

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Mariano, F., Leporati, M., Carignano, P. et al. Urine volume as a predicting factor for furosemide clearance during continuous infusion in AKI septic shock patients on hemodiafiltration. J Nephrol 31, 889–897 (2018). https://doi.org/10.1007/s40620-018-0537-8

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  • DOI: https://doi.org/10.1007/s40620-018-0537-8

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