Daily urinary creatinine predicts the weaning of renal replacement therapy in ICU acute kidney injury patients

Nicolas Viallet,Romaric Larcher,Delphine Daubin,Kada Klouche,Nils Kuster,Vincent Brunot,Aurèle Buzançais,Noémie Besnard,Olivier Jonquet,Laura Platon

doi:10.1186/s13613-016-0176-y

Abstract

BackgroundIn acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient’s outcome. In this study, we aimed to identify predictive parameters that may help to a successful RRT weaning for AKI patients.MethodsWe studied 54 surviving AKI patients in which a weaning of RRT was attempted. On the day of weaning (D0) and the following 2 days (D1 and D2), SAPS II and SOFA scores, 24-h diuresis, 24-h urinary creatinine and urea (UCr and UUr), creatinine and urea generation rates (CrGR and UrGR) and clearances (CrCl and UrCl) were collected. Patients who remained free of RRT 15 days after its discontinuation were considered as successfully weaned.ResultsTwenty-six RRT weaning attempts succeeded (S+) and 28 failed (S−). Age, previous renal function, SAPS II and SOFA scores were comparable between groups. At D0, 24-h diuresis was 2300 versus 1950 ml in S+ and S−, respectively, p = 0.05. At D0, D1 and D2, 24-h UUr and UCr levels, UrCl and CrCl, and UUr/UrGR and UCr/CrGR ratios were significantly higher in S+ group. By multivariate analysis, D1 24-h UCr was the most powerful parameter that was associated with RRT weaning success with an area under the ROC curve of 0.86 [0.75–0.97] and an odds ratio of 2.01 [1.27–3.18], p = 0.003.ConclusionsIn ICU AKI, 24-h UCr appeared as an efficient and independent marker of a successful weaning of RRT. A 24-h UCr ≥5.2 mmol was associated with a successful weaning in 84 % of patients.

Highlights

In acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient’s outcome
Patients with hemodynamic instability or severe fluid overload were preferentially treated with pre-dilutional continuous venovenous hemodiafiltration (CVVHDF) or on-line sustained low-efficiency daily dialysis-filtration (SLEDDf ), and those with hemodynamic stability were preferentially treated with on-line intermittent hemodiafiltration (IHDF) [27]
In summary, the usefulness of 24-h urine output to predict the success of RRT weaning in AKI patients treated by diuretics may be significantly altered

Summary

Introduction

In acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient’s outcome. 5 % of ICU patients suffering from AKI require renal replacement therapy (RRT) [1]. Such patients have a hospital mortality rate of 45–70 % [1,2,3,4,5,6], and those surviving to hospital discharge continue to carry a high risk for long-term morbidity and mortality [7,8,9,10]. Renal function in AKI surviving patients requiring RRT recovers in the vast majority of case (more than 90 % of patients) [14]. Renal biopsy in patients with prolonged AKI treated by hemodialysis showed regions

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