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Multicenter Study
. 2025 Jul 1;29(1):261.
doi: 10.1186/s13054-025-05289-8.

Effects of the urinary urea excretion index on the decision to wean ICU patients with acute kidney injury from renal replacement therapy: a before-after multicentre study (D-STOP)

Simon Bodot #  1 , Alexandre Gros #  1   2 , Lisa Le Gall  3 , Aurélie Martin  4 , Chloé Gisbert-Mora  5 , Jerome Pillot  5 , Claire Ragot  4 , Hubert Grand  4 , Antoine Romen  6 , Alexandre Masri  6 , Antoine Dewitte  7   8 , Didier Gruson  1   9 , Renaud Prevel  1   9 , Sebastien Rubin  10   11 , Arthur Orieux  1   11 , Alexandre Boyer  12   13
Affiliations
Multicenter Study

Effects of the urinary urea excretion index on the decision to wean ICU patients with acute kidney injury from renal replacement therapy: a before-after multicentre study (D-STOP)

Simon Bodot et al. Crit Care. .

Abstract

Background: The weaning of critical care patients with acute kidney injury (AKI) from renal replacement therapy (RRT) lacks predictive criteria. The urinary urea excretion index (UUEI) based on the urine urea concentration and diuresis may be a relevant prognostic criterion. The aim of this study was to assess the value of utilising a UUEI-based weaning protocol from a RRT catheter.

Methods: This was a multicentre before-after study including patients with non-obstructive AKI requiring RRT during their intensive care unit (ICU) stay. A before cohort (2013-2015) was compared to an after cohort (2017-2019) in the interval of which a UUEI-based weaning protocol was implemented. In the after cohort, as soon as the UUEI exceeded 1.35 mmol/kg/24 h, physicians were encouraged to stop RRT and withdraw the catheter, whereas in the before cohort the catheter was withdrawn at the physician's discretion. The primary outcome was the number of RRT catheter-free days on day 28 after initiating RRT.

Results: In total, 179 and 130 patients were included in the before and after cohorts, respectively. The median numbers of catheter-free days in the before and after cohorts on day 28 were 13.0 (IQR 0.0-21.0) vs. 16.5 (IQR 4.3-24.0), respectively (p = 0.02). The adjusted rate ratio for the number of catheter-free days over the number of days at risk was 1.11 (95% CI 1.03-1.19; p = 0.006) in favour of the after cohort. Catheters were reinserted to resume RRT in 3 vs. 5 patients in the before and after cohorts, respectively.

Conclusions: These results confirm that a UUEI-based protocol is a safe technique to prompt withdrawal of the RRT catheter in patients with AKI requiring RRT during their ICU stay.

Trial registration: ClinicalTrials.gov NCT03763188.

Keywords: Acute kidney injury; Intensive care unit; Renal replacement therapy; Urinary urea excretion index.

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Conflict of interest statement

Declarations. Ethical approval: The study was approved by the French commission for individual freedom “Commission Nationale des Libertés Individuelles (CNIL)” and the ethic committee of the intensive care unit French society “Société de Réanimation de langue Française (SRLF)”. Consent for publication: All patients accepted their personal data to be registered and used for clinical research purpose. Competing interests: LLG: none CG: none JP: none AM: none CR: none HG: received fees from Baxter, Freseniusnone AR: none AD: received grant support from MSDavenir; fees for conferences symposium from MSD, Pfizer, Novartis, Baxter, Cytosorb, ISep; fees for participation to advisory board from Ocean Dx DG: none RP: none SR; received fees from AstraZeneca, Servier, Novartis, Fresenius, Meditor, Alexion AO: none AB none.

Figures

Fig. 1
Fig. 1
The weaning course for the dialysis catheter. * Time of RRT initiation was defined as the time of catheter insertion (T0). **Recovery of significant diuresis (RSD) was defined as > 0.5 mL/kg/h of urine output. Last RRT and catheter withdrawal could happen before or after RSD
Fig. 2
Fig. 2
Flow chart
Fig. 3
Fig. 3
Allen Johnson survival analysis of the risk of catheter withdrawal
See this image and copyright information in PMC

Comment in

References

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