Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea.
Blood Purif. 2021;50(6):779-789. doi: 10.1159/000512350. Epub 2021 Mar 18.
Continuous renal replacement therapy (CRRT) is the standard treatment for severe acute kidney injury in critically ill patients. However, a practical consensus for discontinuing CRRT is lacking. We aimed to develop a prediction model with simple clinical parameters for successful discontinuation of CRRT.
Adult patients who received CRRT at Samsung Medical Center from 2007 to 2017 were included. Patients with preexisting ESRD and patients who progressed to ESRD within 1 year or died within 7 days after CRRT were excluded. Successful discontinuation of CRRT was defined as no requirement for renal replacement therapy for 7 days after discontinuing CRRT. Patients were assigned to either a success group or failure group according to whether discontinuation of CRRT was successful or not.
A total of 1,158 patients were included in the final analyses. The success group showed greater urine output on the day before CRRT discontinuation (D-1) and the discontinuation day (D0). Multivariable analysis identified that urine output ≥300 mL on D-1, and mean arterial pressure 50∼78 mm Hg, serum potassium <4.1 mmol/L, and BUN <35 mg/dL (12.5 mmol/L) on D0 were predictive factors for successful discontinuation of CRRT. A scoring system using the 4 variables above (area under the receiver operating curve: 0.731) was developed.
Scoring system composed of urine output ≥300 mL/day on D-1, and adequate blood pressure, serum potassium <4.1 mmol/L, and BUN <35 mg/dL (12.5 mmol/L) on D0 was developed to predict successful discontinuation of CRRT.
连续肾脏替代疗法（CRRT）是重症患者严重急性肾损伤的标准治疗方法。然而，对于停止 CRRT 缺乏实用共识。我们旨在开发一种具有简单临床参数的预测模型，以成功停止 CRRT。
纳入 2007 年至 2017 年在三星医疗中心接受 CRRT 的成年患者。排除患有预先存在的 ESRD 患者和在 CRRT 后 1 年内进展为 ESRD 或在 CRRT 后 7 天内死亡的患者。成功停止 CRRT 定义为停止 CRRT 后 7 天内无需进行肾脏替代治疗。根据 CRRT 是否成功停止，将患者分为成功组或失败组。
共有 1158 名患者纳入最终分析。成功组在 CRRT 停止前一天（D-1）和停止日（D0）的尿量更大。多变量分析确定，D-1 时尿量≥300 mL，D0 时平均动脉压 50∼78 mmHg、血清钾<4.1 mmol/L 和 BUN<35 mg/dL（12.5 mmol/L）是成功停止 CRRT 的预测因素。使用上述 4 个变量（接受者操作特征曲线下面积：0.731）开发了一个评分系统。
该评分系统由 D-1 时每日尿量≥300 mL，以及 D0 时足够的血压、血清钾<4.1 mmol/L 和 BUN<35 mg/dL（12.5 mmol/L）组成，用于预测 CRRT 的成功停止。
