Discontinuation of continuous kidney replacement therapy in patients with acute kidney injury: A pilot study

BACKGROUND: Data on discontinuing continuous kidney replacement therapy (CKRT) in acute kidney injury (AKI) remain limited. We investigated whether a standardized approach improved successful CKRT discontinuation. METHODS: This was a pilot prospective study of patients with AKI requiring CKRT in the intensive care unit between 7/2021-3/2024. In the intervention arm, a standardized form was completed daily to guide discontinuation of CKRT. Successful discontinuation was defined as being free from kidney replacement therapy for seven consecutive days. A 2-h creatinine clearance and cystatin C were done at the time of CKRT discontinuation in both arms. RESULTS: We screened 373 patients, 32 were included in the standard care and 35 in the intervention arm after satisfying the inclusion criteria. Patients in the intervention arm were more likely to be older (65 vs. 57 years) and require more norepinephrine (0 vs. 0.11 μg/kg/min) on the first day of CKRT compared to standard care. Among survivors at day 7 after CKRT discontinuation, successful discontinuation occurred in 16/23 (69.6%) in the standard care arm versus 19/26 (73.1%) in the intervention arm. When discontinuation was encouraged, CKRT was stopped in 26/35 (74%); when not encouraged, CKRT continued in 53/59 (90%). Performances of cystatin C alone or in combination with 2-h creatinine clearance in predicting successful discontinuation was fair. The best performance was observed in the intervention cohort, AUROC of 0.8 (95% CI, 0.57-0.99). CONCLUSION: A standardized approach did not improve the rate of successful CKRT discontinuation. Future studies are needed before biomarkers are used in decision-making.