Predictive Factors for Successful Discontinuation of Continuous Renal Replacement Therapy: A Retrospective...

Determining the optimal timing for discontinuing continuous renal replacement therapy (CRRT) in intensive care units (ICUs) remains a significant clinical challenge. This study aimed to identify the clinical and laboratory determinants of successful CRRT discontinuation in critically ill patients with acute kidney injury (AKI).

This retrospective, single-center observational study was conducted in Gülhane Training and Research Hospital, Ankara, Türkiye. A total of 396 patients who received CRRT between January 2019 and March 2023 were screened. After excluding patients with prior renal replacement therapy (RRT) (n = 66) and end-stage kidney disease (n = 250), 80 patients were included in the final analysis. Successful discontinuation was defined as independence from any RRT for at least seven consecutive days following CRRT cessation. Clinical variables were compared between the successful and unsuccessful groups.  Results. The mean age of the patients was 71.16 ± 14.96 years. In univariate analysis, successful discontinuation was significantly associated with higher 24-h urine output during CRRT [385 (0-3880) mL vs. 100 (0-1850) mL; P = .010], a stable or decreasing lactate trend in the first four hours (69% vs. 40%; P = .033), and a lower requirement for invasive mechanical ventilation (36.4% vs. 58.3%; P = .050). Receiver operating characteristic (ROC) curve analysis identified 24-h urine output as a significant predictor of success (Area under the curve (AUC) = 0.666; 95% Confidence interval (CI): 0.546-0.786; P = .011) with a threshold of 365 cc/24h (sensitivity: 52.3%, specificity: 80.6%). In the final logistic regression model, urine output in the last 24 hours remained an independent predictor of weaning success (Odds ratio (OR) = 1.001; 95% CI: 1.000-1.002; P = .009).

The 24-h urine output preceding CRRT termination and the trend of lactate levels during the 4-hour period post-initiation are important predictive values for the success of CRRT discontinuation.