A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

•Score to predict successful RRT discontinuation in AKI.•Timely catheter removal.•Comparison among different strategies to assess.•Creatinine variation. Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creati...

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Published in:Clinics (São Paulo, Brazil) Vol. 78; p. 100280
Main Authors: Valle, Eduardo de Oliveira, Smolentzov, Igor, Gorzoni, João Lucas Martins, Salgado, Isabela Cavalcante, Mainardes, Lorena Catelan, Gomes, Vanessa Oliveira, Júnior, Charles Hamilton Mélo, Rodrigues, Camila Eleuterio, Júnior, José Mauro Vieira
Format: Journal Article
Language:English
Published: United States Elsevier España, S.L.U 01-01-2023
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo
Faculdade de Medicina / USP
Subjects:
Acute kidney injury
Acute Kidney Injury - therapy
Catheter removal
Creatinine
Discontinuation
Hemodialysis
Humans
MEDICINE, GENERAL & INTERNAL
Original
Renal Dialysis
Renal Replacement Therapy
Retrospective Studies
Score
Score
Discontinuation
Catheter removal
Hemodialysis
Acute kidney injury
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Summary:•Score to predict successful RRT discontinuation in AKI.•Timely catheter removal.•Comparison among different strategies to assess.•Creatinine variation. Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the “Success” group and opposed to the “Failure” group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. We included 124 patients, 49 in the “Failure” group and 75 in the “Success” group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.
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These authors contributed equally to this work.
ISSN:1807-5932
1980-5322
1980-5322
DOI:10.1016/j.clinsp.2023.100280