Predictors of successful discontinuation from renal replacement therapy during AKI: A meta‐analysis

Wang, Liya; Li, Jiameng; Sun, Si; Du, Hao; Chen, Pengfan; Xu, Yuansheng; Shen, Yao; Xin, Shuzi; Dan, Yuqing; Li, Hancong; Chen, Junda; Li, Zi; Su, Baihai

doi:10.1111/sdi.12936

Cited by 6 publications

(4 citation statements)

References 26 publications

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“…Our ndings demonstrated a substantial correlation between urine volume upon CRRT discontinuation and successful deconditioning, with an ideal cutoff value of 730 ml/day and an AUC value of 0.929, in line with Joan et al [26]. There is a lot of variation in urine volume measurements among research, perhaps because different studies employ different times to test urine volume [35] and probably because the impact of CRRT on urine volume cannot be ignored.…”

Section: Baseline Characteristics Of the Patients Tablesupporting

confidence: 87%

Predictive value of renal resistance index on the timing of CRRT weaning in patients with acute kidney injury in ICU

Zhang

et al. 2023

Preprint

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Background: Few studies have been undertaken to establish the optimal time for discontinuing continuous renal replacement therapy (CRRT) in individuals with acute kidney injury (AKI). This study aimed to find prospective renal biomarkers or clinical signs that could indicate successful CRRT deconditioning. Methods： A prospective observational study was carried out on 45 patients wt CRRT who discontinued following renal recovery. When patients did not require CRRT for at least 7 days, they were regarded as successfully discharged. Patients who resumed dialysis within seven days were deemed unsuccessful. Results: 24 (53.3%) of the 45 patients examined were successfully released from CRRT. The 24-h urine volume after weaning cessation, the renal resistance index (RRI) after cessation, and the creatinine ratio on the day of weaning and the day following weaning were determined to be variables impacting the effectiveness of CRRT cessation in a multivariate model. The RRI AUC-ROC after CRRT discontinuation was 0.872 (0.76 -0.99), and the 24-h urine volume AUC-ROC was 0.929. (0.84-1.00). The AUC-ROC for the 24-h urine volume after CRRT discontinuation was 0.929 (0.84-1.00), and the creatinine ratio on the first day following CRRT cessation vs the day of weaning was 0.643 (0.476-0.810). Conclusions: RRI was the main risk factor of successful CRRT weaning.

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Section: Baseline Characteristics Of the Patients Tablesupporting

confidence: 87%

Predictive value of renal resistance index on the timing of CRRT weaning in patients with acute kidney injury in ICU

Zhang

et al. 2023

Preprint

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“…Urine volume is reported to predict successful CRRT discontinuation as summarized in online suppl. Table S9 includes four meta-analyses [ 5 , 6 , 8 , 17 ] and multiple other studies [ 18 − 35 ]. Even though we have confirmed that urine volume was the strongest predictive parameter for CRRT discontinuation, it did not demonstrate a significant ability to predict long-term outcomes, such as MAKEs within 90 days.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with AKI who need continuous renal replacement therapy (CRRT) have a particularly poor prognosis [1][2][3][4]. Although multiple randomized controlled studies have tried to reveal the question of when to start CRRT, only a small number of observational studies have been conducted so far to answer the question of when to stop CRRT [5][6][7][8]. Further, the guidelines from the Kidney Disease: Improving Global Outcome (KDIGO) organization similarly do not clearly state an answer to the "when to stop CRRT" question.…”

Section: Introductionmentioning

confidence: 99%

Different Roles of Functional and Structural Renal Markers Measured at Discontinuation of Renal Replacement Therapy for Acute Kidney Injury

Yoshida,

Matsuura,

Komaru

et al. 2023

Blood Purif

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Introduction: Severe acute kidney injury (AKI) requiring renal replacement therapy (RRT) has been associated with an unacceptably high mortality of 50% or more. Successful discontinuation of RRT is thought to be linked to better outcomes. Although functional and structural renal markers have been evaluated in AKI, little is known about their roles in predicting outcomes at the time of RRT discontinuation. Methods: In this prospective single-center cohort study, we analyzed patients who received continuous RRT (CRRT) for AKI between August 2016 and March 2018 in the intensive care unit of the University of Tokyo Hospital (Tokyo, Japan). Clinical parameters and urine samples were obtained at CRRT discontinuation. Successful CRRT discontinuation was defined as neither resuming CRRT for 48 h nor receiving intermittent hemodialysis for 7 days from the CRRT termination. Major adverse kidney events (MAKEs) were defined as death, requirement for dialysis, or a decrease in the estimated glomerular filtration rate (eGFR) of more than 25% from the baseline at day 90. Results: Of 73 patients, who received CRRT for AKI, 59 successfully discontinued CRRT and 14 could not. Kinetic eGFR, urine volume, urinary neutrophil gelatinase-associated lipocalin (NGAL), and urinary L-type fatty acid binding protein were predictive for CRRT discontinuation. Of these factors, urine volume had the highest area under the curve (AUC) 0.91 with 95% confidence interval [0.80–0.96] for successful CRRT discontinuation. For predicting MAKEs at day 90, the urinary NGAL showed the highest AUC 0.76 [0.62–0.86], whereas kinetic eGFR and urine volume failed to show statistical significance (AUC 0.49 [0.35–0.63] and AUC 0.59 [0.44–0.73], respectively). Conclusions: Our prospective study confirmed that urine volume, a functional renal marker, predicted successful discontinuation of RRT and that urinary NGAL, a structural renal marker, predicted long-term renal outcomes. These observations suggest that the functional and structural renal makers play different roles in predicting the outcomes of severe AKI requiring RRT.

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“…Wang et al performed a meta-analysis of 10 observational studies to evaluate routine laboratory parameters as predictors of successful weaning in AKI-D. Not surprisingly, the authors noted that surrogate parameters of renal function such as urine output, urinary urea and creatinine excretion rate, and serum creatinine as well as parameters of electrolyte (serum potassium) or acidbase homoeostasis (serum bicarbonate, pH) were significantly associated with weaning success [19]. Other tools for prediction of renal recovery from AKI-D encompass patient-related factors (age, higher SOFA score) or AKI-D-associated factors (duration of renal support, a diuresis < 400 ml and not increasing spontaneously or responding adequate to diuretic challenge, presence of hypervolemia and degree of azotaemia) [16,17,20,21].…”

Section: Score Systems To Predict Aki-d Recoverymentioning

confidence: 99%

Anticipation of recovery of native renal function and liberation from renal replacement therapy in critically ill patients with severe acute kidney injury

Schiffl

2022

Ren Replace Ther

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Background Renal replacement therapy (RRT) is used to manage critically ill patients with severe acute kidney injury (AKI-D), and it is undoubtedly life-sustaining for most patients. However, the prolonged unnecessary use of these techniques may be harmful. At present, no consensus guidelines provide specific recommendations for clinicians on when (optimal timing of discontinuation) and how (liberation or weaning) to stop RRT in intensive care unit (ICU) patients with recovering native kidney function. Methods and results Numerous variables such as clinical parameters, classical surrogate markers for glomerular filtration rate, novel biomarkers of kidney function and damage, and new imaging techniques in AKI-D have been described to predict successful discontinuation of RRT. Most available studies are limited by study design, heterogeneity of variable assessment and thresholds of biomarkers, and lack of prospective validation. At present, the decision on discontinuation of RRT in ICU patients is based on three clinical scenarios: (a) intrinsic kidney function (defined as spontaneous urine output > 500 ml/24 h, timed creatinine clearance > 15 to 20 ml/min) has adequately improved to match the demands and continued RRT is no longer consistent with goals of care (transition to intermittent RRT); (b) the acute illness that prompted RRT has improved; (c) the clinical practice of switching haemodynamic stable patients with persistent AKI-D from continuous RRTs to intermittent RRTs is variable, but de-escalation of RRT (frequency, dose) may facilitate mobilization and discharge of ICU patients. Conclusions The predictive ability of novel kidney biomarkers, surrogate markers of kidney function, and direct measurements of kidney function should be evaluated in future studies.

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Predictors of successful discontinuation from renal replacement therapy during AKI: A meta‐analysis

Cited by 6 publications

References 26 publications

Predictive value of renal resistance index on the timing of CRRT weaning in patients with acute kidney injury in ICU

Predictive value of renal resistance index on the timing of CRRT weaning in patients with acute kidney injury in ICU

Different Roles of Functional and Structural Renal Markers Measured at Discontinuation of Renal Replacement Therapy for Acute Kidney Injury

Anticipation of recovery of native renal function and liberation from renal replacement therapy in critically ill patients with severe acute kidney injury

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