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Abstract: TH-PO048

Temporal and External Validation of the Prediction Model for Successful Discontinuation of Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Seo, Minsuk, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Lee, Sehun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Yoon, Sung Bin, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Jeon, Junseok, 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, Yoon-Goo, 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

Continuous renal replacement therapy (CRRT) is widely used as a preferred modality of renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI). However, there is no consensus criterion for discontinuing CRRT. We evaluated the usefulness of the prediction model developed in our previous study through one temporal cohort and four external cohorts.

Methods

A total of 1517 critically ill patients with AKI who underwent CRRT from 2018 to 2020 in five medical centers were included in the validation. Patients who underwent CRRT for more than 2 days and survived for 7 or more days after CRRT discontinuation were selected. Successful discontinuation of CRRT was defined as not restarting RRT for 7 days after CRRT discontinuation. The prediction model was composed of d four variables: urine output (≥ 300 mL/day, score 4) on the day before discontinuation and blood urea nitrogen (BUN < 35 mg/dL, score 2), serum potassium (< 4.1 mmol/L, score 1), and mean arterial blood pressure (50-78 mmHg, score 1) on the discontinuation day.

Results

The prediction model showed area under the curve of the receiver-operating characteristic (AUC-ROC) curve 0.74 (95% CI 0.71-0.76) in pooled analysis of all cohorts. Overall differences between observed and predicted incidence rates were 3.0% (17.7% observed and 16.9% predicted probability), 3.6% (35.2% and 34.8%), and 2.0% (69.3% and 70.3%) in the low- (0-2 points), intermediate- (3-5 points), and high-score (6-8 points) groups, respectively. In an analysis of each cohort, four cohorts including one temporal cohort showed similar good discriminatory power (AUC-ROC 0.770, 0.731, 0.735, and 0.725, respectively), while one cohort showed poor discriminatory power (AUC-ROC 0.556).

Conclusion

Our prediction model for successful discontinuation of CRRT in critically ill patients showed good performance in one temporal and three external cohorts, with poor performance in one external cohort. Our results support the need of an appropriate protocol for the discontinuation of CRRT.