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Cited by 105Acute Kidney Injury ResearchSepsis Diagnosis and TreatmentDialysis and Renal Disease Management

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Determining the optimal time for liberation from renal replacement therapy in critically ill patients: a systematic review and meta-analysis (DOnE RRT)

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Katulka, Riley Jeremy, Al Saadon, Abdalrhman, Sebastianski, Meghan, Featherstone, Robin, Vandermeer, Ben, Silver, Samuel A., Gibney, R. T. Noel, Bagshaw, Sean M., Rewa, Oleksa G.·2020·Critical Care
DOI 10.1186/s13054-020-2751-8PMC PMC7020497
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Abstract

Introduction: Renal replacement therapy (RRT) is associated with high mortality and costs; however, no clinical guidelines currently provide specific recommendations for clinicians on when and how to stop RRT in recovering patients. Our objective was to systematically review the current evidence for clinical and biochemical parameters that can be used to predict successful discontinuation of RRT. Methods: A systematic review and meta-analysis were performed with a peer-reviewed search strategy combining the themes of renal replacement therapy (IHD, CRRT, SLED), predictors of successful discontinuation or weaning (defined as an extended period of time free from further RRT), and patient outcomes. Major databases were searched and citations were screened using predefined criteria. Studied parameters were reported and, where possible, data was analyzed in the pooled analysis. Results: Our search yielded 23 studies describing 16 variables for predicting the successful discontinuation of RRT. All studies were observational in nature. None were externally validated. Fourteen studies described conventional biochemical criteria used as surrogates of glomerular filtration rate (serum urea, serum creatinine, creatinine clearance, urine urea excretion, urine creatinine excretion). Thirteen studies described physiologic parameters such as urine output before and after cessation of RRT, and 13 studies reported on newer kidney biomarkers, such as serum cystatin C and serum neutrophil gelatinase-associated lipocalin (NGAL). Six studies reported sensitivity and specificity characteristics of multivariate models. Urine output prior to discontinuation of RRT was the most-studied variable, with nine studies reporting. Pooled analysis found a sensitivity of 66.2% (95% CI, 53.6–76.9%) and specificity of 73.6% (95% CI, 67.5–79.0%) for urine output to predict successful RRT discontinuation. Due to heterogeneity in the thresholds of urine output used across the studies, an optimal threshold value could not be determined. Conclusions: Numerous variables have been described to predict successful discontinuation of RRT; however, available studies are limited by study design, variable heterogeneity, and lack of prospective validation. Urine output prior to discontinuation of RRT was the most commonly described and robust predictor. Further research should focus on the determination and validation of urine output thresholds, and the evaluation of additional clinical and biochemical parameters in multivariate models to enhance predictive accuracy.

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Metadata

Authors
Katulka, R. J., Al Saadon, A., Sebastianski, M., Featherstone, R., Vandermeer, B., Silver, S. A., Gibney, R. T. N., Bagshaw, S. M., & Rewa, O. G.
Affiliations
  • University of Alberta (CA)
  • Queen's University (CA)
Corresponding author
Rewa, Oleksa G.
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2020-02-13
Volume
24
Issue
1
Pages
50-50
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-020-2751-8
PMC
PMC7020497
OpenAlex
W3005795094
Cited by
105
References
5
Citations by year
2026: 20 · 2025: 19 · 2024: 23 · 2023: 13 · 2022: 22 · 2021: 5 · 2020: 3
FWCI
1.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Canadian Society of Nephrology
  • University of Alberta
  • Kidney Foundation of Canada
  • Alberta Innovates
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
renal replacement therapy, critically ill patients, urine output, renal biomarkers, cystatin C, neutrophil gelatinase-associated lipocalin, serum urea, serum creatinine, glomerular filtration rate, continuous renal replacement therapy, intermittent hemodialysis, acute kidney injury
MeSH terms
Duration of Therapy, Creatinine, Glomerular Filtration Rate, Humans, Prognosis, Biomarkers, Critical Illness, Renal Replacement Therapy

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