Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients

Aniort, Julien; Hssain, Ali Ait; Pereira, Bruno; Coupez, Elisabeth; Pioche, Pierre Antoine; Leroy, C.; Heng, Anne Elisabeth; Souweine, Bertrand; Lautrette, Alexandre

doi:10.1186/s13054-016-1225-5

Cited by 37 publications

(35 citation statements)

References 33 publications

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“…Daily urinary urea excretion is used less often but appears to be superior [81] . Results of an observational study conducted in 2000-2002 in 54 ICUs in 23 countries showed that a spontaneous urine output of 400 ml/day was associated with an 80.9% chance of successful liberation from RRT [80] .…”

Section: How Should Patients Be Liberated From Rrt?mentioning

confidence: 99%

“…Patients in whom CRRT was discontinued successfully had better outcomes than patients who needed to be restarted on RRT. A retrospective single-center cohort study of 60 patients treated with IRRT for at least 7 days for AKI in an ICU of a French university hospital concluded that a daily urinary urea excretion greater than 1.35 mmol/kg/24 h was the best marker for weaning ICU patients with AKI from IRRT, followed by urine output greater than 8.5 ml/kg/24 h [81] . The areas under the receiver operating characteristics curves of daily urinary urea excretion and urine output were 0.96 and 0.86, respectively.…”

Section: How Should Patients Be Liberated From Rrt?mentioning

confidence: 99%

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Patient Selection and Timing of Continuous Renal Replacement Therapy

et al. 2016

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When and in whom to initiate continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) remains a highly controversial topic with large practice variation around the world. Even within countries, practice variation exists and recommendations for clinical practice are not specific. In this article, we report the consensus recommendations for timing and patient selection for CRRT - the results of the 2016 Acute Disease Quality Initiative XVII conference on ‘precision CRRT'. We suggest that these recommendations could serve to develop the best clinical practice and standards of care for use of CRRT in patients with AKI. Finally, we identify and highlight the areas of ongoing uncertainty and propose an agenda for future research.

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Section: How Should Patients Be Liberated From Rrt?mentioning

confidence: 99%

Section: How Should Patients Be Liberated From Rrt?mentioning

confidence: 99%

Patient Selection and Timing of Continuous Renal Replacement Therapy

et al. 2016

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“…Five studies [11,17,[24][25][26] found that urine output at the time of cessation of CRRT was important for predicting successful CRRT discontinuation. Uchino et al [11] reported that urine output (OR 1.078/100 mL/ day) and creatinine level (OR 0.996 μmol/L) were significant predictors of successful CRRT discontinuation, and the AUROC curve values for urine output without diuretics and creatinine were 0.808 and 0.635, respectively.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…Katayama et al [17] also reported that urine output (OR 1.09/100 mL/day) and creatinine level (OR 0.99 μmol/L) were significant predictors of successful CRRT, and the AUROC curve values for urine output and creatinine were 0.814 and 0.727, respectively. Aniort et al [26] found that the optimal diagnostic thresholds for intermittent hemodialysis weaning were a urine output greater than 8.5 mL/kg/24 h, urinary urea concentration greater than 148 mmol/L, and daily urea excretion greater than 1.35 mmol/kg/24 h, with accuracies of 82.1, 76.1, and 92.5% (p = 0.03), respectively. Wu et al [24] reported the following independent predictors for RRT within 30 days: a long duration of RRT (OR 1.06 day), a high SOFA score (OR 1.44 score), presence of oliguria on the day of discontinuation (OR 4.17; urine output, < 100 mL/8 h), and age > 65 years (OR 6.35).…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

Chen

Wei

et al. 2019

Blood Purif

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Background: To determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) by evaluating serum neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI). Methods: A prospective observational study was conducted from September 2015 to March 2018. AKI patients treated with CRRT for at least 24 h were divided into “success” and “failure” groups according to their RRT requirement within 7 days after the initial discontinuation of CRRT. The prefilter and effluent NGAL concentrations were measured to calculate the sieving coefficient (SC) of NGAL in all included subjects from 0 to 72 h. Results: In total, 110 patients were divided into success (n = 78) and failure groups (n = 32). The mean SC of NGAL during CRRT was less than 0.05. The patients in the failure group were associated with higher mortality compared with patients in the success group (37.5 vs. 12.8%, respectively, p = 0.013). There were significant differences in serum NGAL, creatinine, and urine output at discontinuation. In patients without sepsis (n = 70), serum NGAL and urine output were significant predictors of successful cessation. The area under the receiver operating characteristic to predict the successful discontinuation of CRRT was 0.88 for NGAL and 0.86 for urine output. An NGAL level of 403 ng/mL had the highest sensitivity (81%) and specificity (89%) and a urine output of 695 mL/day had the highest sensitivity (83%) and specificity (88%). However, in septic patients (n = 40), urine output but not serum NGAL (OR 0.999, p = 0.69) was a significant variable (OR 1.002, p = 0.005), with a cutoff of 796 mL/day (sensitivity 83%, specificity 88%). Conclusions: Serum NGAL was a significant factor for predicting successful CRRT discontinuation in nonseptic AKI patients. However, urine output, rather than serum NGAL, was a significant predictor in septic AKI patients.

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“…Recently, daily urinary urea excretion (24 h-urinary urea, 24h-UU) and daily urinary creatinine excretion (24 h-urinary creatinine, 24h-UCr) have been evaluated in 2 different single-center retrospective studies. Both have been demonstrated to be superior than other markers and 24h-UCr than 24h-UU in predicting RRT weaning success [104,105]. …”

Section: Recovery From Aki and Risk To Develop Ckdmentioning

confidence: 99%

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

Rosa

Samoni²,

Villa³

et al. 2017

Blood Purif

3,608

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Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). ‘Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD.

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Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients

Cited by 37 publications

References 33 publications

Patient Selection and Timing of Continuous Renal Replacement Therapy

Patient Selection and Timing of Continuous Renal Replacement Therapy

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

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