Criteria for Continuous Kidney Replacement Therapy Cessation in ICU Patients

Meint Volbeda*, Martha Oord, Jacqueline Koeze, Eric Keus, Iwan C C van der Horst, Casper F M Franssen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: In intensive care unit (ICU) patients with acute kidney injury, specific recommendations to guide the decision to cease continuous kidney replacement therapy (CKRT) are lacking.

METHODS: We performed a survey to identify criteria currently used to cease CKRT in real-life clinical practice in the Netherlands. We used an online questionnaire with multiple choice questions designed with web-based software from SurveyMonkey.

RESULTS: We received 169 completed questionnaires from intensivists (n = 126) and nephrologists (n = 43). Essential determinants for the cessation of CKRT were a spontaneously increasing diuresis (indicated by 92% of the respondents), absence of fluid overload (indicated by 88% of the respondents), and improvement in creatinine clearance (indicated by 61% of the respondents; intensivists 56%; nephrologists 77%, p = 0.03). Most often mentioned cut-off values used for increase in diuresis were 0.25 and 0.5 mL/kg/h (35% and 33%, respectively). Actual CKRT cessation was often postponed until the filter clots or until circuit disconnection is needed because of patient transport for diagnostic or intervention procedures (indicated by 58% of the respondents). Expected discharge from the ICU was the most frequently reported determinant to switch from CKRT to hemodialysis (indicated by 67% of the respondents).

CONCLUSIONS: CKRT cessation in clinical practice is mostly based on spontaneously increasing diuresis, absence of fluid overload, and improvement in creatinine clearance and is often delayed until filter clotting or disconnection of the circuit because of logistic reasons.

Original languageEnglish
Pages (from-to)23-40
Number of pages9
JournalBlood Purification
Volume52
Early online date19 Apr 2022
DOIs
Publication statusPublished - 2023

Keywords

  • Acute kidney injury
  • CRITICALLY-ILL PATIENTS
  • Continuous kidney replacement therapy
  • Continuous renal replacement therapy
  • INITIATION
  • INJURY
  • Intensive care
  • RENAL RECOVERY
  • SUCCESSFUL DISCONTINUATION
  • Survey

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