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Continuous renal replacement therapy (CRRT) is the cornerstone of supportive treatment for severe acute kidney injury (AKI). However, the withdrawal of CRRT in patients with severe AKI has not been standardized, and there are conflicting recommendations regarding the optimal timing of its interruption. Emerging data have shown that the premature release of CRRT and unnecessary and prolonged CRRT are likely to have a negative impact on the clinical course and economic burden of AKI. Therefore, releasing TRRC patients at the right time is essential from the perspective of health and safety resource utilization.
New evidence suggests that releasing CRRT too soon, as well as unneeded and extended CRRT, might negatively affect the clinical course and economic cost of AKI. Therefore, from the point of view of health and safety resource usage, it is crucial to release TRRC patients at the appropriate time. The objective of this study is to evaluate and compare the effect of urinary output on CRRT withdrawal.
A retrospective cohort of critically ill adult patients hospitalized in four intensive care units of a tertiary care center in western Mexico who presented with acute kidney injury requiring CRRT, in which renal replacement therapy (RRT) was interrupted without the intention of migrating to another form of RRT, from January 2016 to March 2021. We defined CRRT withdrawal success as 72 hours without the need for a TRR reset after CRRT discontinuation. (Jeon et al. 2018).
Fifty-two patients who met the inclusion criteria were evaluated. 52 clinical records meeting the inclusion criteria were evaluated. Due to the abnormal distribution of the uresis values in both groups, it was decided to carry out the analysis by quartiles, finding the distribution regarding the success or failure of CRRT withdrawal. We found that uresis below the first quartile (<1,000 ml) was a risk factor for failure to withdraw CRRT (OR 2.85, 95% CI 1.84–4.41, p<0.001). Other variables that showed a risk of CRRT withdrawal failure in the multivariate analysis were lower systolic and diastolic blood pressure, the presence of comorbidities, more total hours of CRRT, and the absence of diuretic use at the time of CRRT withdrawal.
A urine output of less than 1 liter was associated with almost three times the risk of failure to withdraw CRRT in our population. In turn, diuretics facilitate withdrawal. In our population, a urinary output below 1 liter was associated with almost three times the odds of failure to withdraw CRRT. In turn, diuretic use facilitated withdrawal. Urinary volumes were greater in our CRRT-withdrawing study compared to those reported in other places. Our population with CRRT withdrawal had higher urinary volumes than other populations described in the literature.
This abstract was also submitted for the Kidney Week-Annual Meeting, 2023, ASN congress. By submitting the abstract to WCN’24, abstract authors declare that re-submitting the abstract is permitted by the organizers of the previous meeting.