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Prolonged exposure to continuous renal replacement therapy in patients with acute kidney injury

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Abstract

Background

Little is known about the process of deciding to discontinue continuous renal replacement therapy (CRRT) in patients with acute kidney injury (AKI) and the impact of CRRT duration on outcomes.

Methods

We report the clinical parameters of prolonged CRRT exposure and predictors of doubling of serum creatinine or need for dialysis at 90 days after CRRT with propensity score matching, including covariates that were likely to influence patients in the prolonged CRRT group.

Results

Among 104 survey responders, most use urine output (87%) to guide CRRT discontinuation, 24% use improvement in clinical or hemodynamic status. In the cohort study, of 854 included patients, 465 participated in the assessment of kidney recovery. Patients with prolonged CRRT had higher SOFA scores (11.9 vs. 11.2) and were more likely to be mechanically ventilated (99% vs. 84%) at CRRT initiation compared to patients without prolonged CRRT, p-value < 0.05. In multivariable logistic regression, daily urine output and cumulative fluid balance leading to CRRT discontinuation or day seven were independently associated with lower [OR 0.87 per 200 ml/day increase] and higher odds [OR 1.03 per 1-L increase] of requiring prolonged CRRT, respectively. After propensity score matching, prolonged exposure to CRRT was independently associated with increased risk of doubling serum creatinine or dialysis at 90 days, OR 3.1 (95% CI 1.23–8.3 p = 0.017).

Conclusions

Resolution of critical illness and signs of kidney recovery are important factors when considering CRRT discontinuation. Prolonged CRRT exposure may be associated with less chance of kidney recovery among survivors.

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Availability of data and material

The data underlying this article will be shared upon reasonable request to the corresponding author.

Code availability

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Khaled Shawwa, Panagiotis Kompotiatis & Kianoush B. Kashani

  2. Section of Nephrology, Department of Medicine, West Virginia University, Morgantown, WV, USA

    Khaled Shawwa

  3. Division of Cardiovascular Critical Care, Department of Cardiovascular and Thoracic Surgery, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA

    Ankit Sakhuja, Paul McCarthy & Kianoush B. Kashani

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Kianoush B. Kashani

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  1. Khaled Shawwa
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Correspondence to Kianoush B. Kashani.

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The institutional review board approved this project and waived the need for informed consent for patients who provided research authorization due to the minimal risk of this chart review study.

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Shawwa, K., Kompotiatis, P., Sakhuja, A. et al. Prolonged exposure to continuous renal replacement therapy in patients with acute kidney injury. J Nephrol 35, 585–595 (2022). https://doi.org/10.1007/s40620-021-01097-9

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  • DOI: https://doi.org/10.1007/s40620-021-01097-9

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