Abstract
BackgroundContinuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT.MethodsThis was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72 h from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24 h after CRRT discontinuation. The cumulated urine output was measured for 24 h prior to discontinuation and at 6, 12, and 24 h after discontinuation. Missing uNGAL values were calculated by interpolation. The Youden’s index was used to calculate cut-off values in order to define uNGAL and urine output single variable and 2-variable diagnostic tests with the optimum prediction of successful CRRT discontinuation.ResultsBaseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, the REC group had significantly higher urine output (p < 0.0001) and lower uNGAL (p < 0.001) at all time points, except for uNGAL at 24 h (p < 0.24). The best uNGAL predictor for successful CRRT discontinuation was uNGAL at 6 h after discontinuation (predictive value 80%). The best single predictor was cumulated urine output 24 h before discontinuation (predictive value 85%). The combinations of uNGAL at 6 h (cut-off 1650 μg/L) with cumulated urine output 24 h prior to discontinuation (cut-off 210 ml) proved to be the superior tests (using either “or” or “and”), with predictive values of 93% (successful CRRT discontinuation) and 92% (dialysis dependency).ConclusionsWith a predictive value of 93%, the combination of uNGAL at 6 h after and the cumulated urine output 24 h prior to CRRT cessation proved to be the best diagnostic test for successful CRRT discontinuation in ICU patients.Clinical trial registrationN/A
Highlights
Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI)
continuous renal replacement therapy (CRRT) is discontinued on an individual basis, i.e., when the physician assesses that the general state of the patient could indicate renal recovery
The decision as to when to initiate/discontinue CRRT was at the discretion the intensive care unit (ICU) physicians on duty, and it was based on the complex physiology and individualized presentation of the critically ill patient/critically ill patient in recovery
Summary
Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI). The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT. The physician would have access to a test with high diagnostic sensitivity for predicting renal recovery This is, complicated by the complex physiology and individualized presentation of the critically ill patient. Few studies have focused on the ability of uNGAL to predict renal recovery in critically ill patients at the time of discontinuation of dialysis [14–16]. It may be argued that the longer the timeframe from discontinuation until the uNGAL level is determined, the less clinically relevant the biomarker becomes
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