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Multicenter Study
. 2019;48(3):243-252.
doi: 10.1159/000501387. Epub 2019 Jul 22.

Predictors of 90-Day Restart of Renal Replacement Therapy after Discontinuation of Continuous Renal Replacement Therapy, a Prospective Multicenter Study

Susanne Stads  1   2 , K Merijn Kant  3 , Margriet F C de Jong  4 , Wouter de Ruijter  5 , Christa M Cobbaert  6 , Michiel G H Betjes  7 , Diederik Gommers  8 , Heleen M Oudemans-van Straaten  9
Affiliations
Multicenter Study

Predictors of 90-Day Restart of Renal Replacement Therapy after Discontinuation of Continuous Renal Replacement Therapy, a Prospective Multicenter Study

Susanne Stads et al. Blood Purif. 2019.

Abstract

Background: Restart of renal replacement therapy (RRT) after initial discontinuation of continuous RRT (CRRT) is frequently needed. The aim of the present study was to evaluate whether renal markers after discontinuation of CRRT can predict restart of RRT within 90 days.

Methods: Prospective multicenter observational study in 90 patients, alive, still on the intensive care unit at day 2 after discontinuation of CRRT for expected recovery with urinary neutrophil gelatinase-associated lipocalin (NGAL) available. The endpoint was restart of RRT within 90 days. Baseline and renal characteristics were compared between outcome groups no restart or restart of RRT. Logistic regression and receiver operator characteristic curve analysis were performed to determine the best predictive and discriminative variables.

Results: Restart of RRT was needed in 32/90 (36%) patients. Compared to patients not restarting, patients restarting RRT demonstrated a higher day 2 urinary NGAL, lower day 2 urine output, and higher incremental creatinine ratio (day 2/0). In multivariate analysis, only incremental creatinine ratio (day 2/0) remained independently associated with restart of RRT (OR 5.28, 95% CI 1.45-19.31, p = 0.012). The area under curve for incremental creatinine ratio to discriminate for restart of RRT was 0.76 (95% CI 0.64-0.88). The optimal cutoff was 1.49 (95% CI 1.44-1.62).

Conclusion: In this prospective multicenter study, incremental creatinine ratio (day 2/0) was the best predictor for restart of RRT. Patients with an incremental creatinine ratio at day 2 of 1.5 times creatinine at discontinuation are likely to need RRT within 90 days. These patients might benefit from nephrological follow-up.

Keywords: Acute kidney injury; Continuous renal replacement therapy; Discontinuation; Neutrophil gelatinase-associated lipocalin.

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Conflict of interest statement

The department of intensive care of the Erasmus Medical Centre received an unrestricted research grant from Dirinco. H.O.M.S. is an associate editor of Blood Purification, received speaker”™s honorary, and participated in advisory meetings from Fresenius, Baxter/Gambro, and Dirinco.

Figures

Fig. 1
Fig. 1
Flowchart. ICU, intensive care unit; RRT, renal replacement therapy; CRRT, continuous RRT; NGAL, neutrophil gelatinase-associated lipocalin.
Fig. 2
Fig. 2
Clinical course of the study patients and associated NGAL concentrations. NGAL, neutrophil gelatinase-associated lipocalin, NGAL results in median (25th–75th percentile). NGAL is expressed in ng/mL. ICU, intensive care unit; RRT, renal replacement therapy; NGAL, neutrophil gelatinase-associated lipocalin.
Fig. 3
Fig. 3
Cumulative number of patients restarting RRT. CRRT, continuous renal replacement therapy.
Fig. 4
Fig. 4
ROC curve of creatinine ratio (day 2/0) for discrimination of restart of RRT within 90 days. AUC, area under the curve.
See this image and copyright information in PMC

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