Predictors of short-term successful discontinuation of continuous renal replacement therapy: results from a prospective multicentre study

Stads, Susanne; Kant, K Merijn; Jong, Margriet F C de; Ruijter, Wouter de; Cobbaert, Christa; Betjes, M.; Gommers, Diederik; Straaten, Heleen M. Oudemans–van

doi:10.1186/s12882-019-1327-9

Cited by 41 publications

(40 citation statements)

References 22 publications

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“…Another study [Biological Markers of Recovery for the Kidney (BioMark)] by Srisawat et al [15] also indicated the ability of uNGAL to predict more lasting kidney damage. Finally, a study from 2019 by Stads et al [16] included 92 patients and tested 7 variables, including uNGAL 2 days after the discontinuation of dialysis. Renal recovery was de ned as freedom from dialysis 7 days after discontinuation.…”

Section: Discussionmentioning

confidence: 99%

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Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Thomsen

Sprogøe

Toft

2020

Preprint

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Background: Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT.Methods: This was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72 hours from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24 hours after CRRT discontinuation. The cumulated urine output was measured for 24 hours prior to discontinuation and at 6, 12, and 24 hours after discontinuation. Missing uNGAL values were calculated by interpolation. The Youden’s index was used to calculate cut-off values in order to define uNGAL and urine output single variable and 2-variable diagnostic tests with the optimum prediction of successful CRRT discontinuation. Results: Baseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, the REC group had significantly higher urine output (p<0.0001) and lower uNGAL (p<0.001) at all time points, except for uNGAL at 24 hours (p<0.24). The best uNGAL predictor for successful CRRT discontinuation was uNGAL at 6 hours after discontinuation (predictive value 80%). The best single predictor was cumulated urine output 24 hours before discontinuation (predictive value 85%). The combinations of uNGAL at 6 hours (cut-off 1650 µg/L) with cumulated urine output 24 hours prior to discontinuation (cut-off 210 ml) proved to be the superior tests (using either “or” or “and”), with predictive values of 93% (successful CRRT discontinuation) and 92% (dialysis dependency).Conclusions: With a predictive value of 93%, the combination of uNGAL at 6 hours after and the cumulated urine output 24 hours prior to CRRT cessation proved to be the best diagnostic test for successful CRRT discontinuation in ICU patients.Clinical trial registration: N/A

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Section: Discussionmentioning

confidence: 99%

“…A decrease in uNGAL might therefore represent renal recovery. Few studies have focused on the ability of uNGAL to predict renal recovery in critically ill patients at the time of discontinuation of dialysis [14][15][16]. In these studies, uNGAL was determined 24 hours or later after discontinuation.…”

Section: Introductionmentioning

confidence: 99%

Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Thomsen

Sprogøe

Toft

2020

Preprint

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“…2000 ml/d mit Diuretika kann über die Pausierung einer Nierenersatzterapie nachgedacht werden [41]. Auch die Höhe des Kreatininanstieges in der RRT-Pause oder die 6-h-Kreatininclearance eignen sich als Prädiktor [42] für den erfolgreichen Auslass der Nierenersatztherapie.…”

Section: Mach Mal Pause -Wann Sollte Die Nierenersatztherapie Pausierunclassified

Nierenersatztherapie auf der Intensivstation

Kielstein

Eden

2020

Klinikarzt

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ZUSAMMENFASSUNGDie akute Nierenschädigung tritt heute vor allem bei Intensivpatienten nach großen operativen Eingriffen, mit Sepsis oder im Rahmen des Versagens eines oder mehrerer anderer Organe auf. Intensivpatienten, die einer Nierenersatztherapie bedürfen, haben eine Krankenhausmortalität von ca. 60 %. Der Zeitpunkt des Beginns der Nierenersatztherapie ist Gegenstand zahlreicher Studien gewesen. Zu den hartnäckigsten Legenden in der Medizin zählt jene zum Harnstoff-Schwellenwert, der die Notwendigkeit einer Nierenersatztherapie anzeigen soll. Zwei rezente Arbeiten zeigen, dass allein ein durch den Laborwert getriggerter Dialysebeginn, z. B. Erfüllung der AKIN-3-Kriterien, dazu führt, dass knapp die Hälfte der Patienten eine Dialysetherapie bekommen, die sie nicht benötigt. Bezüglich der Dosis der Nierenersatztherapie konnte eine Meta-Analyse belegen, dass neben einem fehlenden Vorteil einer hohen Intensität der Nierenersatztherapie auf die Mortalität sogar die Wiederaufnahme der Nierenfunktion verzögert wird. Unter der hohen Dosis der heutzutage eingesetzten Nierenersatzverfahren kommt es auch zur vermehrten Elimination von Elektrolyten, Nährstoffen und Antibiotika, denn die Anpassung von Antibiotika an die Intensität der Nierenersatztherapie ist schwierig. Für die Behandlung der akuten Nierenschädigung stehen mehrere Nierenersatzverfahren zur Verfügung: die klassische intermittierende Hämodialyse, die kontinuierliche Nierenersatztherapie (CVVH), die verlängerte tägliche Dialyse (PIRRT/SLED/GENIUS-Dialyse) und die Peritonealdialyse. Trotz intensiver Forschungsbemühungen in diesem Gebiet gibt es bisher keine Studie, die die Überlegenheit eines dieser Verfahren in Bezug auf die Mortalität oder renale Endpunkte wie z. B. die Wiederaufnahme der Nierenfunktion belegen. Gegenwärtig gibt es auch keinen Konsens bezüglich der Kriterien für die Beendigung der Nierenersatztherapie. Die Menge des Urins scheint jedoch ein guter Parameter zu sein, auch die Höhe des Kreatininanstieges in der RRT-Pause (RRT: renal replacement therapy) oder die 6-h-Kreatininclearance eignen sich als Prädiktor für den erfolgreichen Auslass der Nierenersatztherapie.

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“…Some studies proposed that biomarkers can be used to predict the development of a severe AKI and need for RRT [6,7]. However, only a few studies investigated the use of biomarkers to predict successful discontinuation of CRRT [8][9][10][11]. Newer biomarkers, TIMP-2*IGFBP7, have been shown to be able to predict long term outcome and renal recovery [12,13].…”

Section: Introductionmentioning

confidence: 99%

TIMP-2*IGFBP7 as an auxiliary identification of successful discontinuation CRRT and prediction of renal recovery in critically ill patients: a case control study

Xie

Zarbock

Brendolan

et al. 2020

Preprint

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Background Cell cycle arrest biomarkers as TIMP-2*IGFBP7 are elevated in the Acute Kidney Stress and can predict the probability of developing Acute Kidney Injury (AKI). Approximately 25% of those patients with AKI deteriorate clinically and are unable to maintain adequate homeostasis, eventually requiring continuous renal replacement therapy. However, when clinical improvement occurs, the ideal mode of weaning patients from CRRT is an unmet medical need. Methods We performed a prospective single-center study of AKI patients treated with CRRT between October 2017 to April 2019 in a multidisciplinary ICU of an Italian hospital. All patients admitted to ICU requiring CRRT were enrolled. Urine samples for measuring urinary TIMP-2*IGFBP7 levels were collected immediately upon enrollment and at the moment when CRRT was discontinued. The primary endpoint was independence from RRT for at least 7 days after CRRT discontinuation. Renal recovery, which was defined as serum creatinine (SCr) level <1.5 times the baseline value at ICU discharge or day 28, was the secondary endpoint. Results 73 patients were enrolled of whom 45 patients effectively discontinued CRRT (61.6%). The patients with a TIMP-2*IGFBP7 concentration >2(ng/ml) 2 /1000 at enrollment were longer CRRT-dependent. The ROC-AUC values for the prediction of successful discontinuation with TIMP-2*IGFBP7 concentrations at enrollment, at discontinuation of CRRT and with the final model were 0.828, 0.814 and 0.882, respectively. The risk for CRRT discontinuation failure was nearly 5 times higher patients with a positive biomarker at CRRT discontinuation (OR 4.879, P=0.043), and 3.5 times higher in patients with a TIMP-2*IGFBP7 concentration >2(ng/ml) 2 /1000 at patient enrollment (OR 3.515, P=0.016). Multivariate Cox regression analysis showed a significant association between successful discontinuation of CRRT and TIMP-2*IGFBP7-negative patients at CRRT discontinuation (RR 0.436, 95% CI 0.202-0.939, P=0.034). Kaplan-Meier curves revealed that TIMP-2*IGFBP7 concentration <2 (ng/ml) 2 /1000 at enrollment and TIMP-2*IGFBP7 turning negative were positively related to high renal recovery rate. Conclusions Urinary TIMP-2*IGFBP7 can serve as a biomarker for identifying successful discontinuation CRRT and predicting renal recovery in critically ill patients.

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Predictors of short-term successful discontinuation of continuous renal replacement therapy: results from a prospective multicentre study

Cited by 41 publications

References 22 publications

Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Nierenersatztherapie auf der Intensivstation

TIMP-2*IGFBP7 as an auxiliary identification of successful discontinuation CRRT and prediction of renal recovery in critically ill patients: a case control study

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