When to stop renal replacement therapy in patients with acute kidney injury_West China Medical Journal

Authors：

XUE Jinhong , CHEN Lei , WEI Meng , YAN Senhui ,  JIANG Hongli

Department of Blood Purification, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, P. R. China;

Corresponding author：

JIANG Hongli, Email: j92106@sina.com

Keywords：

Acute kidney injury; renal replacement therapy; timing of stopping

DOI：

10.7507/1002-0179.202205141

Video：

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Acute kidney injury is a common complication in the critically ill patients with high morbidity and mortality. Continuous renal replacement therapy (CRRT) is one of the most important treatments for the disease. The timing of starting and stopping of CRRT is often a matter of choice for clinicians. Early stopping of CRRT may lead to inadequate treatment, recurrent disease and poor prognosis, while excessive treatment of CRRT may prolong the hospital stay, increase medical costs and increase the risk of CRRT-related complications. In order to illustrate the proper stopping time of CRRT, this paper summarizes the research progress of the clinical indicators and biomarkers by reviewing relevant domestic and foreign data.

Citation： XUE Jinhong, CHEN Lei, WEI Meng, YAN Senhui, JIANG Hongli. When to stop renal replacement therapy in patients with acute kidney injury. West China Medical Journal, 2022, 37(7): 974-978. doi: 10.7507/1002-0179.202205141 Copy

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2.	Davenport A, Will EJ, Davidson AM. Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med, 1993, 21(3): 328-338.
3.	Uchino S, Bellomo R, Ronco C. Intermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid-base balance. Intensive Care Med, 2001, 27(6): 1037-1043.
4.	Andrikos E, Tseke P, Balafa O, et al. Epidemiology of acute renal failure in ICUs: a multi-center prospective study. Blood Purif, 2009, 28(3): 239-244.
5.	Thakar CV, Christianson A, Freyberg R, et al. Incidence and outcomes of acute kidney injury in intensive care units: a veterans administration study. Crit Care Med, 2009, 37(9): 2552-2558.
6.	Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012, 1(Suppl 2): 1-138.
7.	Kellum JA, Ronco C. The 17th acute disease quality initiative international consensus conference: introducing precision renal replacement therapy. Blood Purif, 2016, 42(3): 221-223.
8.	Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
9.	Chen WY, Cai LH, Zhang ZH, et al. The timing of continuous renal replacement therapy initiation in sepsis-associated acute kidney injury in the intensive care unit: the CRTSAKI Study (Continuous RRT Timing in Sepsis-associated AKI in ICU): study protocol for a multicentre, randomised controlled trial. BMJ Open, 2021, 11(2): e040718.
10.	Uchino S, Bellomo R, Morimatsu H, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med, 2009, 37(9): 2576-2582.
11.	Wu VC, Ko WJ, Chang HW, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med, 2008, 34(1): 101-108.
12.	Aniort J, Ait Hssain A, Pereira B, et al. Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients. Crit Care, 2016, 20: 43.
13.	van der Voort PH, Boerma EC, Koopmans M, et al. Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit Care Med, 2009, 37(2): 533-538.
14.	Viallet N, Brunot V, Kuster N, et al. Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients. Ann Intensive Care, 2016, 6(1): 71.
15.	Hansrivijit P, Yarlagadda K, Puthenpura MM, et al. A meta-analysis of clinical predictors for renal recovery and overall mortality in acute kidney injury requiring continuous renal replacement therapy. J Crit Care, 2020, 60: 13-22.
16.	郑欣. 预测连续肾脏替代治疗成功停机的相关因素. 石家庄: 河北医科大学, 2021.
17.	Yoshida T, Matsuura R, Komaru Y, et al. Kinetic estimated glomerular filtration rate as a predictor of successful continuous renal replacement therapy discontinuation. Nephrology (Carlton), 2019, 24(3): 287-293.
18.	Herrera-Gutiérrez ME, Seller-Pérez G, Banderas-Bravo E, et al. Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study. Intensive Care Med, 2007, 33(11): 1900-1906.
19.	Fröhlich S, Donnelly A, Solymos O, et al. Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy. J Crit Care, 2012, 27(6): 744.e1-e5.
20.	VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med, 2008, 359(1): 7-20.
21.	Murray PT, Mehta RL, Shaw A, et al. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int, 2014, 85(3): 513-521.
22.	Siew ED, Ikizler TA, Gebretsadik T, et al. Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol, 2010, 5(8): 1497-1505.
23.	Parikh CR, Coca SG, Thiessen-Philbrook H, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol, 2011, 22(9): 1748-1757.
24.	Coca SG, Yalavarthy R, Concato J, et al. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int, 2008, 73(9): 1008-1016.
25.	Srisawat N, Wen X, Lee M, et al. Urinary biomarkers and renal recovery in critically ill patients with renal support. Clin J Am Soc Nephrol, 2011, 6(8): 1815-1823.
26.	Moon SJ, Park HB, Yoon SY, et al. Urinary biomarkers for early detection of recovery in patients with acute kidney injury. J Korean Med Sci, 2013, 28(8): 1181-1186.
27.	Kim CS, Bae EH, Ma SK, et al. A prospective observational study on the predictive value of serum cystatin c for successful weaning from continuous renal replacement therapy. Kidney Blood Press Res, 2018, 43(3): 872-881.
28.	Chen X, Chen Z, Wei T, et al. The effect of serum neutrophil gelatinase-associated lipocalin on the discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury. Blood Purif, 2019, 48(1): 10-17.
29.	Meersch M, Schmidt C, Van Aken H, et al. Urinary TIMP-2 and IGFBP7 as early biomarkers of acute kidney injury and renal recovery following cardiac surgery. PLoS One, 2014, 9(3): e93460.

1. Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int, 2013, 84(3): 457-467.
2. Davenport A, Will EJ, Davidson AM. Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure. Crit Care Med, 1993, 21(3): 328-338.
3. Uchino S, Bellomo R, Ronco C. Intermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid-base balance. Intensive Care Med, 2001, 27(6): 1037-1043.
4. Andrikos E, Tseke P, Balafa O, et al. Epidemiology of acute renal failure in ICUs: a multi-center prospective study. Blood Purif, 2009, 28(3): 239-244.
5. Thakar CV, Christianson A, Freyberg R, et al. Incidence and outcomes of acute kidney injury in intensive care units: a veterans administration study. Crit Care Med, 2009, 37(9): 2552-2558.
6. Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012, 1(Suppl 2): 1-138.
7. Kellum JA, Ronco C. The 17th acute disease quality initiative international consensus conference: introducing precision renal replacement therapy. Blood Purif, 2016, 42(3): 221-223.
8. Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
9. Chen WY, Cai LH, Zhang ZH, et al. The timing of continuous renal replacement therapy initiation in sepsis-associated acute kidney injury in the intensive care unit: the CRTSAKI Study (Continuous RRT Timing in Sepsis-associated AKI in ICU): study protocol for a multicentre, randomised controlled trial. BMJ Open, 2021, 11(2): e040718.
10. Uchino S, Bellomo R, Morimatsu H, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med, 2009, 37(9): 2576-2582.
11. Wu VC, Ko WJ, Chang HW, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med, 2008, 34(1): 101-108.
12. Aniort J, Ait Hssain A, Pereira B, et al. Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients. Crit Care, 2016, 20: 43.
13. van der Voort PH, Boerma EC, Koopmans M, et al. Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit Care Med, 2009, 37(2): 533-538.
14. Viallet N, Brunot V, Kuster N, et al. Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients. Ann Intensive Care, 2016, 6(1): 71.
15. Hansrivijit P, Yarlagadda K, Puthenpura MM, et al. A meta-analysis of clinical predictors for renal recovery and overall mortality in acute kidney injury requiring continuous renal replacement therapy. J Crit Care, 2020, 60: 13-22.
16. 郑欣. 预测连续肾脏替代治疗成功停机的相关因素. 石家庄: 河北医科大学, 2021.
17. Yoshida T, Matsuura R, Komaru Y, et al. Kinetic estimated glomerular filtration rate as a predictor of successful continuous renal replacement therapy discontinuation. Nephrology (Carlton), 2019, 24(3): 287-293.
18. Herrera-Gutiérrez ME, Seller-Pérez G, Banderas-Bravo E, et al. Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study. Intensive Care Med, 2007, 33(11): 1900-1906.
19. Fröhlich S, Donnelly A, Solymos O, et al. Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy. J Crit Care, 2012, 27(6): 744.e1-e5.
20. VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med, 2008, 359(1): 7-20.
21. Murray PT, Mehta RL, Shaw A, et al. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int, 2014, 85(3): 513-521.
22. Siew ED, Ikizler TA, Gebretsadik T, et al. Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol, 2010, 5(8): 1497-1505.
23. Parikh CR, Coca SG, Thiessen-Philbrook H, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol, 2011, 22(9): 1748-1757.
24. Coca SG, Yalavarthy R, Concato J, et al. Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review. Kidney Int, 2008, 73(9): 1008-1016.
25. Srisawat N, Wen X, Lee M, et al. Urinary biomarkers and renal recovery in critically ill patients with renal support. Clin J Am Soc Nephrol, 2011, 6(8): 1815-1823.
26. Moon SJ, Park HB, Yoon SY, et al. Urinary biomarkers for early detection of recovery in patients with acute kidney injury. J Korean Med Sci, 2013, 28(8): 1181-1186.
27. Kim CS, Bae EH, Ma SK, et al. A prospective observational study on the predictive value of serum cystatin c for successful weaning from continuous renal replacement therapy. Kidney Blood Press Res, 2018, 43(3): 872-881.
28. Chen X, Chen Z, Wei T, et al. The effect of serum neutrophil gelatinase-associated lipocalin on the discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury. Blood Purif, 2019, 48(1): 10-17.
29. Meersch M, Schmidt C, Van Aken H, et al. Urinary TIMP-2 and IGFBP7 as early biomarkers of acute kidney injury and renal recovery following cardiac surgery. PLoS One, 2014, 9(3): e93460.

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