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Kidney Week

Abstract: SA-PO558

Predictive Factors for Successful Discontinuation of Continuous Renal Replacement Therapy in AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Baeg, Song in, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Boo, Hyo jin, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Minjung, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Lee, Eun jeong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Dae Joong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Yoon-Goo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Oh, Ha Young, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
Background

Although continuous renal replacement therapy (CRRT) is the standard treatment for severe acute kidney injury (AKI) in critically ill patients, there is no practical consensus for discontinuing CRRT. In this retrospective study, predictive factors for successful discontinuation of CRRT was investigated.

Methods

Adult patients (≥18 years) who received CRRT at Samsung Medical Center from June 2007 to June 2017 were included (n=4166). Patients with preexisting end stage renal disease (ESRD), patients who progressed to ESRD within 1 year after CRRT discontinuation or died within 7 days were excluded. Successful discontinuation of CRRT was defined as no requirement of RRT for 7 days after discontinuing CRRT. Patients were divided into the failure group and the success group. Clinical information and laboratory results were collected via electronic medical records.

Results

A total of 1158 patients were analyzed. There were no differences in comorbidities. The duration of CRRT was longer in the failure group. Mean arterial pressure (MAP) on discontinuation day (D0) was lower in the success group (failure vs. success, 80.86±12.56 vs. 78.95±12.51 mmHg, p=0.010). Urine output on the day before discontinuation (D-1) (140 vs. 648 mL/day, p<0.001) and D0 (253 vs. 1298 mL/day, p<0.001) and the proportion of patients who received vasopressors on D-1 (26.6% vs. 43.1%, p<0.001) and D0 (19.1% vs. 34.8%, p<0.001) were higher in the success group. Serum potassium on D0 was lower in the success group (4.02±0.45 vs. 3.88±0.46 mmol/L, p<0.001). Multivariable analysis showed that urine output on D0 (odds ratio [OR], 1.621; 95% confidence interval [CI], 1.468 to 1.789; p<0.0001), difference in HCO3 between D0 and D-1 (OR, 1.070; CI, 1.009 to 1.135; p=0.0231) and vasopressor use on D0 (OR, 2.306; CI, 1.348 to 3.946; P=0.0023) were significant predictive factors for successful discontinuation of CRRT. MAP on D0 (OR, 0.980; CI, 0.969 to 0.992; p=0.0007) and serum potassium on D0 (OR, 0.592; CI, 0.732 to 0.809; p=0.001) were also significant predictive factors.

Conclusion

Our study showed that greater urine output, maintenance of adequate blood pressure with vasopressors, and lower normal range of serum potassium on discontinuation day were associated with successful discontinuation of CRRT.