Predictive value of FST for renal replacement therapy in patients with acute kidney injury: a meta-analysis

The furosemide stress test (FST) has been used as a predictor for renal replacement therapy (RRT), yet its reported performance varies across studies. This meta-analysis aimed to evaluate the predictive value of FST for RRT in patients with acute kidney injury (AKI). We searched PubMed, Embase, Cochrane, CNKI, and Wanfang Medical databases up to December 13, 2025, for prospective or retrospective cohort studies reporting the predictive performance of FST for RRT. This trial has been registered in PROSPERO (CRD42024570956). A total of 14 studies with 3506 AKI patients were included. The pooled sensitivity and specificity of FST in predicting RRT were 0.76 (95% CI 0.67–0.83) and 0.77 (95% CI 0.69–0.84), respectively. The pooled positive likelihood ratio was 3.36 (95% CI 2.44–4.26), and the pooled negative likelihood ratio was 0.31 (95% CI 0.22–0.43). The area under the summary receiver operating characteristic curve was 0.83. When integrated into a combined prediction model, FST demonstrated enhanced prognostic accuracy for RRT compared with its use as a stand-alone test. These findings suggest that FST is a promising bedside tool for identifying patients with AKI who are a high risk of requiring RRT.