Predicting restoration of kidney function during CRRT-free intervals

Abstract

BackgroundRenal failure is common in critically ill patients and frequently requires continuous renal replacement therapy (CRRT). CRRT is discontinued at regular intervals for routine changes of the disposable equipment or for replacing clogged filter membrane assemblies. The present study was conducted to determine if the necessity to continue CRRT could be predicted during the CRRT-free period.Materials and methodsIn the period from 2003 to 2006, 605 patients were treated with CRRT in our ICU. A total of 222 patients with 448 CRRT-free intervals had complete data sets and were used for analysis. Of the total CRRT-free periods, 225 served as an evaluation group. Twenty-nine parameters with an assumed influence on kidney function were analyzed with regard to their potential to predict the restoration of kidney function during the CRRT-free interval. Using univariate analysis and logistic regression, a prospective index was developed and validated in the remaining 223 CRRT-free periods to establish its prognostic strength.ResultsOnly three parameters showed an independent influence on the restoration of kidney function during CRRT-free intervals: the number of previous CRRT cycles (medians in the two outcome groups: 1 vs. 2), the "Sequential Organ Failure Assessment"-score (means in the two outcome groups: 8.3 vs. 9.2) and urinary output after the cessation of CRRT (medians in two outcome groups: 66 ml/h vs. 10 ml/h). The prognostic index, which was calculated from these three variables, showed a satisfactory potential to predict the kidney function during the CRRT-free intervals; Receiver operating characteristic (ROC) analysis revealed an area under the curve of 0.798.ConclusionRestoration of kidney function during CRRT-free periods can be predicted with an index calculated from three variables. Prospective trials in other hospitals must clarify whether our results are generally transferable to other patient populations.

NT-proBNP Is Predictive of the Weaning from Continuous Renal Replacement Therapy

“…In particular, some studies have focused on the role of NT-proBNP in the weaning from mechanical ventilation (Determann et al 2013;Zhang et al 2014). In contrast to efforts in the field of mechanical ventilation, few studies have been conducted regarding the CRRT weaning (Uchino et al 2009;Heise et al 2012). A previous observational study has found that both the urine output and serum creatinine level at the time of CRRT discontinuation were associated with a low risk of repeat CRRT (Uchino et al 2009).…”

“…A previous observational study has found that both the urine output and serum creatinine level at the time of CRRT discontinuation were associated with a low risk of repeat CRRT (Uchino et al 2009). Another observational study has revealed that previous CRRT cycles, the Sequential Organ Failure Assessment score, and urine output after cessation of CRRT affected the outcome of CRRT-free interval (Heise et al 2012). These studies focused on the factors observed during CRRT or at the end of CRRT, not at the initiation of 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

“…To the best of our knowledge, other studies have previously assessed factors related to successful CRRT discontinuation, but they did not include serum NGAL [11,17,[24][25][26][27][28]. Five studies [11,17,[24][25][26] found that urine output at the time of cessation of CRRT was important for predicting successful CRRT discontinuation.…”

“…Five studies [11,17,[24][25][26] found that urine output at the time of cessation of CRRT was important for predicting successful CRRT discontinuation. Uchino et al [11] reported that urine output (OR 1.078/100 mL/ day) and creatinine level (OR 0.996 μmol/L) were significant predictors of successful CRRT discontinuation, and the AUROC curve values for urine output without diuretics and creatinine were 0.808 and 0.635, respectively.…”

“…Wu et al [24] reported the following independent predictors for RRT within 30 days: a long duration of RRT (OR 1.06 day), a high SOFA score (OR 1.44 score), presence of oliguria on the day of discontinuation (OR 4.17; urine output, < 100 mL/8 h), and age > 65 years (OR 6.35). Heise et al [25] showed that the following 3 variables were useful to predict the restoration of kidney function: the number of previous CRRT cycles (OR 0.449 cycle), SOFA score (OR 0.449 score), and urine output during the first 8 h after CRRT discontinuation (OR 1.026 mL/h). The other 2 studies did not find a predictive value of urine output for successful RRT discontinuation.…”