Do AKI patients with hypoalbuminemia respond to furosemide stress test without prior albumin infusion?

Background Acute kidney injury (AKI) is a common and serious condition often associated with hypoalbuminemia, which can influence the pharmacokinetics and efficacy of diuretics like furosemide. In critically ill patients, sepsis is the major cause of AKI, accounting for nearly 50% of cases. Objective To evaluate whether AKI patients with hypoalbuminemia can respond to FST without albumin supplementation. Methods This is a prospective quasi-experimental study. Patients were obtained from the intensive care unit of Cairo University Hospital with AKI stages 1 and 2 with hypoalbuminemia. A bolus of furosemide was administered at a dose calculated to be 1-1.5 mg/kg in a single dose to patients without a prior diagnosis of kidney disease and clinical signs of hypovolemia. Results A total of 41 critically ill patients with AKI were enrolled, aged between 18 and 80 years, of which 56.10% had diabetes mellitus, 53.70% were on at least one nephrotoxic medication, and 56.10% had sepsis as the cause of AKI. The median (IQR) albumin level was 1.9 g/dL (1.4–2.7). Among 41 hypoalbuminemic AKI patients included, 80.50% responded to FST without prior albumin infusion. Non-responders had significantly lower baseline serum albumin levels median (IQR) 1(1–2) vs. 2 (1–3) g/dL, p  < 0.002). Conclusion AKI patients with mild-to-moderate hypoalbuminemia may still respond to FST without albumin infusion, although response rates decline with the increasing severity of hypoalbuminemia. The FST remains a valuable predictive tool in hypoalbuminemic AKI patients but warrants further investigation to optimize its utility in this population.