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Kidney Week

Abstract: FR-PO024

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

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Zhang, Ling, West China Hospital of Sichuan University, Chengdu, China
Background

To determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) for critically ill patients with acute kidney injury (AKI) by evaluating serum Neutrophil gelatinase-associated lipocalin (NGAL).

Methods

Patients treated with CRRT at least 24 hours for AKI in ICUs were divided into “success” and “failure” groups according to their renal replacement therapy requirement within 7 days after the initial discontinuation of CRRT.

Results

80 AKI patients were divided into the success (n = 57) and failure groups (n = 23).The patients in failure group was associated with higher mortality compared with successful group (39% vs.14%, p = 0.017). There were significant differences in serum NGAL, creatinine level and urine output at discontinuation between two groups. In patients without sepsis (n = 55), serum NGAL and urine output were found as significant predictors of successful cessation. The area under receiver operating characteristic (AUROC) to predict successful discontinuation of CRRT was 0.85 for NGAL and 0.82 for urine output. NGAL of 403 ng/ml had highest sensitivity (71%) and specificity (85%), as well as urine output of 695 ml/d with highest sensitivity (86%) and specificity (72%). However, in septic patients (n = 25), urine output, but not serum NGAL (OR, 0.990, p =0.43), was a significant variable (OR, 1.005, p =0.044), and the AUROC was 0.861 (p = 0.003), with a cutoff of 793.5 ml (sensitivity 75%, specificity 100%).

Conclusion

Serum NGAL was a significant factor to predict successful CRRT discontinuation in non-septic patients. However, urine output, rather than serum NGAL, was a significant predictor in septic AKI patients.

AUROC and cutoff of NGAL, creatinine and urine output for successful CRRT discontinuation in all included patients

Funding

  • Clinical Revenue Support