Predictors of withdrawal from renal replacement therapy among patients with acute kidney injury requiring renal replacement therapy

Abstract

Background Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear. Methods In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR). Results A total of 334 patients were enrolled (median age, 68 years; interquartile range [IQR], 57-77 years; male, 71.6%). During follow-up 157 (47.0%) patients achieved RRT withdrawal. Multivariable Cox regression analysis revealed that CKD, MAP between 95 and 105 mmHg and MAP ≥ 105 mmHg, compared with MAP between 65 and 75 mmHg, ventilator use and hypoalbuminemia, were significantly associated with RRT withdrawal. Conclusion Among patients with AKI requiring RRT, CKD, ventilator use, hypoalbuminemia, and high MAP were associated with RRT withdrawal. Furthermore, keeping a higher MAP at RRT initiation can potentially lead to dependence on RRT.

Continuous Renal Replacement Therapy Liberation and Outcomes of Critically Ill Patients With Acute Kidney Injury

“…A 72-hour observation period is commonly used and clinically meaningful. 35,[38][39][40][41][42][43][44][45] We believe it is long enough for physicians to determine whether the intrinsic kidney function has adequately recovered. Besides, it is reasonable to postulate that reinstituted RRT after 72 hours in most cases is not the result of the first AKI episode that led to the need for RRT but may indicate those who suffered from a new kidney injury.…”

Prospective model for predicting renal recovery in cardiac surgery patients with acute kidney injury requiring renal replacement therapy

“…Similar results were observed in a prior study, with a decreased chance of renal recovery in patients who experienced mechanical ventilation upon RRT initiation. 28 However, the mechanism underlying this finding is not fully understood. Mechanical ventilation may be an indicator of disease severity.…”