What are Criteria for continuous kidney replacement therapy cessation in ICU patients?
The Netherlands: Cessation of continuous kidney replacement therapy (CKRT) in clinical practice is based on multiple arguments including the absence of fluid overload, spontaneously increasing diuresis, and improvement in creatinine clearance, says a recent study. It is often delayed until filter clotting or disconnection of the circuit because of logistic reasons. The study appears in Blood Purification, the journal of Karger Publication.
There is a lack of specific recommendations to guide the decision to cease continuous kidney replacement therapy in intensive care unit (ICU) patients. Considering this, Meint Volbeda, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, and colleagues aimed to identify criteria currently used to stop CKRT in critical care daily clinical practice.
For this purpose, the researchers used an online questionnaire with multiple-choice questions designed with web-based software from SurveyMonkey. A total of 169 completed questionnaires were received from intensivists (n = 126) and nephrologists (n = 43).
Salient findings of the study include:
- Essential determinants for the cessation of CKRT were a spontaneously increasing diuresis (indicated by 92% of the respondents), absence of fluid overload (indicated by 88% of the respondents), and improvement in creatinine clearance (indicated by 61% of the respondents; intensivists 56%; nephrologists 77%).
- Most often mentioned cut-off values used for increase in diuresis were 0.25 and 0.5 mL/kg/h (35% and 33%, respectively).
- Actual CKRT cessation was often postponed until the filter clots or until circuit disconnection is needed because of patient transport for diagnostic or intervention procedures (indicated by 58% of the respondents).
- Expected discharge from the ICU was the most frequently reported determinant to switch from CKRT to hemodialysis (indicated by 67% of the respondents).
The authors concluded, "In clinical practice, CKRT cessation is mostly based on the absence of fluid overload, spontaneously increasing diuresis, and improvement in creatinine clearance and is often delayed until filter clotting or disconnection of the circuit because of logistic reasons."
Reference:
The study titled, "Criteria for Continuous Kidney Replacement Therapy Cessation in ICU Patients," was published in the journal of Karger Publication Blood Purification.
