Furosemide Stress Test in Adults and Children With Acute Kidney Injury: A Systematic Review and Meta-Analysis
Authors' conclusion
Based on low to very low certainty evidence, the FST may support risk stratification for AKI progression and KRT liberation in critically ill adults. Its impact on mortality when guiding early KRT initiation remains uncertain. As a low-cost bedside test, the FST can be a useful tool in resource-limited settings where novel biomarkers are inaccessible.
Study context
- Population
- Critically ill adults and children with acute kidney injury (AKI)Twenty studies, 11 countries, 2013–2025
- Participants
- 1,979 adults
- Comparison
- Furosemide stress test (FST) for AKI progression, kidney replacement therapy (KRT) initiation, short-term mortality and KRT liberation; FST-guided vs. standard KRT initiation in randomized trials
- Outcome
- AKI progression (AKI stage 3 progression)
Pooled result
As reported in the abstract
| Group | Pooled sensitivity | Specificity | AUC |
|---|---|---|---|
| FST | 0.69 | 0.88 | 0.89 |
FST
Pooled sensitivity0.69
Specificity0.88
AUC0.89
Further pooled results
| Outcome | Values | Pooled risk ratio (95% CI) | |
|---|---|---|---|
| Short-term mortality, FST-guided early KRT initiation vs standard KRT initiationTwo randomized controlled trials, n = 212; GRADE: very low · effect uncertain | 1.00 (0.79–1.27) | ||
| 0.512Pooled risk ratio (log scale) |
| Outcome | Values |
|---|---|
| KRT initiationGRADE: very low | FST sensitivity 0.81 · specificity 0.75 · AUC 0.79 |
| MortalityGRADE: very low | FST sensitivity 0.56 · specificity 0.76 · AUC 0.75 |
| KRT liberationGRADE: low for sensitivity, very low for specificity | FST sensitivity 0.81 · specificity 0.87 · AUC 0.89 |
- KRT initiation: nine studies; n = 952
- Mortality: six studies; n = 487
- KRT liberation: three studies; n = 177
Pediatric analyses
- AUC for KRT initiation
- 0.81
- AUC for mortality
- 0.63
Original publication
Furosemide Stress Test in Adults and Children With Acute Kidney Injury: A Systematic Review and Meta-Analysis. Crit Care Med. Published 21 October 2026. doi:10.
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