Discontinuation of Continuous Renal Replacement Therapy and Dialysis Dependence

Renal replacement therapy (RRT) is a form of extracorporeal support for critical patients, especially for those with acute kidney injury. This therapy enables to gain adequate control over the great metabolic and fluids demand when kidneys are not able to do so; this condition is habitually present in patients who are admitted to intensive care units. However, it is also clear that these patients present a higher mortality rate and, in some cases, complications associated with the therapy. Therefore, it is fundamental to optimize and customize different aspects of RRT that range from the ideal timing including the modality and the dose until its suspension or ending. There currently is a great deal of controversy in all of these RRT-related topics. Although different predictive models have been proposed to determine the optimal timing of therapy discontinuation, nowadays urine output, serum and urine creatinine levels are perhaps the only variables associated with effective discontinuation. Future studies should focus on more accurately predicting renal recovery. This review provides an approach based on current evidence regarding effective discontinuation.