The process of deciding to discontinue continuous renal replacement therapy (CRRT) in patients with acute kidney injury (AKI) and the impact of CRRT duration on outcomes is still unclear for many.

A study reports the clinical parameters of prolonged CRRT exposure and predictors of doubling of serum creatinine or need for dialysis at 90 days after CRRT with propensity score matching, including covariates that are likely to influence patients in the prolonged CRRT group.

Among 104 survey responders, most utilized urine output (87%) to guide CRRT discontinuation, 24% used improvement in clinical or hemodynamic status. 

Patients with prolonged CRRT show higher SOFA scores and are more likely to be mechanically ventilated at CRRT initiation compared to patients without prolonged CRRT.

Daily urine output and cumulative fluid balance leading to CRRT discontinuation or day seven are independently associated with lower [OR 0.87 per 200 ml/day increase] and higher odds [OR 1.03 per 1-L increase] of requiring prolonged CRRT, respectively. 

Prolonged exposure to CRRT is independently associated with an increased risk of doubling serum creatinine or dialysis at 90 days, OR 3.1.

Thus it was concluded that resolution of critical illness and signs of kidney recovery is important when considering CRRT discontinuation. Furthermore, prolonged CRRT exposure may lead to less chance of kidney recovery among survivors.

Source:  J Nephrol. 2021 Jun 23. doi: 10.1007/s40620-021-01097-9. Epub ahead of print. PMID: 34160782.