Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

Abstract

BackgroundIn acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient’s outcome. In this study, we aimed to identify predictive parameters that may help to a successful RRT weaning for AKI patients.MethodsWe studied 54 surviving AKI patients in which a weaning of RRT was attempted. On the day of weaning (D0) and the following 2 days (D1 and D2), SAPS II and SOFA scores, 24-h diuresis, 24-h urinary creatinine and urea (UCr and UUr), creatinine and urea generation rates (CrGR and UrGR) and clearances (CrCl and UrCl) were collected. Patients who remained free of RRT 15 days after its discontinuation were considered as successfully weaned.ResultsTwenty-six RRT weaning attempts succeeded (S+) and 28 failed (S−). Age, previous renal function, SAPS II and SOFA scores were comparable between groups. At D0, 24-h diuresis was 2300 versus 1950 ml in S+ and S−, respectively, p = 0.05. At D0, D1 and D2, 24-h UUr and UCr levels, UrCl and CrCl, and UUr/UrGR and UCr/CrGR ratios were significantly higher in S+ group. By multivariate analysis, D1 24-h UCr was the most powerful parameter that was associated with RRT weaning success with an area under the ROC curve of 0.86 [0.75–0.97] and an odds ratio of 2.01 [1.27–3.18], p = 0.003.ConclusionsIn ICU AKI, 24-h UCr appeared as an efficient and independent marker of a successful weaning of RRT. A 24-h UCr ≥5.2 mmol was associated with a successful weaning in 84 % of patients.

A Prospective Observational Study on the Predictive Value of Serum Cystatin C for Successful Weaning from Continuous Renal Replacement Therapy

“…Patients who had to restart dialysis within 14 days were considered unsuccessful, in accordance with previous studies [15,17,18].…”

“…Uchino et al found that a urine output of > 400 ml/day, without diuretics at CRRT cessation, had the greatest AUC value of 0.845, but diuretics negatively affected the predictive ability of urine output [8]. Additionally, a recent study found that the 24 h urine output at the day of attempt of weaning failed to predict successful weaning from RRT [15]. In line with previous studies [8,15,28], our results showed that urine output at the time of CRRT cessation was not significantly associated with successful weaning, and more than 52% of patients in the restarted RRT group received furosemide.…”

“…Moreover, neutrophil gelatinase-associated lipocalin (NGAL) has been shown to be an early biomarker for predicting AKI before serum creatinine increases [14]. However, to date, data is lacking regarding the biomarkers or clinical factors that could guide clinical decisions on the optimal time to discontinue CRRT or to predict the successful weaning from CRRT in AKI patients [2,10,15]. The aim of our study was to identify the level of serum CysC or serum NGAL, at the time of CRRT cessation, that is associated with successful weaning from CRRT.…”

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

“…The other 2 studies did not find a predictive value of urine output for successful RRT discontinuation. Viallet et al [27] reported that 24-h urine creatinine on the first day after RRT weaning but not urine output was the most powerful parameter for predicting RRT weaning success. Frohlich et al [28] also found that 2-h creatinine clearance was a better predictor of remaining CRRT free at day 7 than urine output or serum creatinine.…”

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

“…Recently, daily urinary urea excretion (24 h-urinary urea, 24h-UU) and daily urinary creatinine excretion (24 h-urinary creatinine, 24h-UCr) have been evaluated in 2 different single-center retrospective studies. Both have been demonstrated to be superior than other markers and 24h-UCr than 24h-UU in predicting RRT weaning success [104,105]. …”