Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy

Fröhlich, Stephen; Donnelly, Amy; Solymos, O; Conlon, Niamh

doi:10.1016/j.jcrc.2012.08.012

Cited by 43 publications

(48 citation statements)

References 28 publications

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“…A retrospective observational study showed that 2‐h creatinine clearance was a good predictive marker for CRRT discontinuation with an area under the ROC curve of 0.82 [0.731–0.910] and a cut‐off value of 23 mL/min . Another retrospective study reported that daily urea excretion 2 days after the last IHD session was the best marker to guide IHD weaning .…”

Section: Discussionmentioning

confidence: 99%

“…Previous retrospective observational studies showed that urine output and 2-h creatinine clearance were good indicators for CRRT discontinuation, 11,12 whereas another retrospective observational study reported daily urea nitrogen excretion as the best predictive marker for intermittent haemodialysis (IHD) weaning. 13 It seems that serum creatinine (sCr) and urine volume are the factors most considered by clinicians when determining whether RRT be discontinued or not.…”

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confidence: 99%

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Kinetic estimated glomerular filtration rate as a predictor of successful continuous renal replacement therapy discontinuation

et al. 2019

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Kinetic estimated glomerular filtration rate as a predictor of successful continuous renal replacement therapy discontinuation

et al. 2019

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“…Viallet et al [27] reported that 24-h urine creatinine on the first day after RRT weaning but not urine output was the most powerful parameter for predicting RRT weaning success. Frohlich et al [28] also found that 2-h creatinine clearance was a better predictor of remaining CRRT free at day 7 than urine output or serum creatinine.…”

Section: Comparison With Previous Studiesmentioning

confidence: 94%

“…To the best of our knowledge, other studies have previously assessed factors related to successful CRRT discontinuation, but they did not include serum NGAL [11,17,[24][25][26][27][28]. 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.…”

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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“…This problem is easier to address on CRRT, where steady‐state levels are usually achieved by the time discontinuation discussions arise. Given time constraints and technical difficulty associated with collecting urine over a 24‐hour period, 12‐hour and even 6‐hour urine collections have been used instead to calculate creatinine clearance and have been shown to be useful surrogate markers for decision‐making regarding weaning of RRT and overall renal recovery . Because of tubular secretion of creatinine, creatinine clearance overestimates the true GFR.…”

Section: Cut‐off Criteria Used In Clinical Trialsmentioning

confidence: 99%

When to stop renal replacement therapy in anticipation of renal recovery in AKI: The need for consensus guidelines

Kelly

Waikar

Mendu

2019

Seminars in Dialysis

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There is wide variation in clinical practice regarding timing of discontinuation of renal replacement therapy (RRT) in patients with acute kidney injury (AKI). Prolonged, unnecessary RRT treatment can contribute to length of stay, overall hospital costs, and risk of complications associated with RRT. In addition, prolonged RRT can paradoxically lengthen the time for which the patient remains dialysis‐dependent. Well‐designed, randomized clinical trials have utilized varied discontinuation criteria specifically related to urine output and creatinine clearance, which impedes the comparison of outcomes from such studies. Other observational studies have attempted to assess the sensitivity and specificity of various criteria for discontinuation of RRT. Whether diuretics influence renal recovery has not been fully elucidated as well. In this article, we propose a starting framework for RRT discontinuation criteria to guide clinicians and clinical researchers. We emphasize the importance of frequent clinical assessment while considering discontinuation of RRT for AKI patients with a creatinine clearance >15 mL/min on a timed urine collection and/or a urine output >400 mL/24 h without diuretics, or >2000 mL/24 h with diuretics. We also discuss newer biomarkers, methods of GFR estimation, and imaging techniques that may play a greater role in the future. Clinical trials objectively comparing the success of RRT discontinuation criteria will be required to provide high‐quality evidence for our proposed guidelines.

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Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy

Cited by 43 publications

References 28 publications

Kinetic estimated glomerular filtration rate as a predictor of successful continuous renal replacement therapy discontinuation

Kinetic estimated glomerular filtration rate as a predictor of successful continuous renal replacement therapy discontinuation

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

When to stop renal replacement therapy in anticipation of renal recovery in AKI: The need for consensus guidelines

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