Factors predicting successful discontinuation of acute kidney replacement therapy: A retrospective cohort study

• Published in: Artificial organs Vol. 47; no. 1; pp. 187 - 197
• Main Authors: Ohara, Cristine Naomi, Suarez, Maria Irma, Kitawara, Koody Hassemi, Zamoner, Welder, Balbi, André Luis, Ponce, Daniela
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2023
• Subjects: acute kidney injury; Acute Kidney Injury - epidemiology; Acute Kidney Injury - therapy; Cardiovascular Diseases; Cohort analysis; Comorbidity; Complications; discontinuation; Humans; Hypertension; Kidney diseases; Kidneys; Mechanical ventilation; Patients; pH effects; predictive factors; Regression analysis; Renal replacement therapy; Renal Replacement Therapy - methods; Retrospective Studies; Risk Factors; Success; Ventilation; renal replacement therapy; acute kidney injury; discontinuation; success; predictive factors
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.14401

Background Treatment for severe acute kidney injury (AKI) typically involves the use of acute kidney replacement therapy (AKRT) to prevent or reverse complications. Methodology We aimed to determine the prevalence of successful discontinuation of AKRT and its predictive factors. A retrospective cohort study was performed with 316 patients hospitalized at a public Brazilian university hospital between January 2011 and June 2020. Results Success and hospital discharge were achieved for most patients (85% and 74%, respectively). Multivariable logistic regression analysis showed that C‐reactive protein (CRP), urine output, and need mechanical ventilation at the time of interruption were variable associated with discontinuation success (OR 0.969, CI 0.918–0.998, p = 0.031; OR 1.008, CI 1.001–1.012, p = 0.041 and OR 0.919, CI 0.901–0.991, p = 0.030; respectively), while the absence of comorbidities such as chronic kidney disease (OR 0.234, CI 0.08–0.683, p = 0.008), cardiovascular disease (OR 0.353, CI 0.134–0.929, p = 0.035) and hypertension (OR 0.278, CI 0.003–0.882, p = 0.009), as well as pH values at the time of AKRT indication (OR 1.273, CI 1.003–1.882, p = 0.041), mechanical ventilation at the time of interruption (OR 0.19, CI 0.19–0.954, p = 0.038) and successful discontinuation (OR 8.657, CI 3.135–23.906, p < 0.001) were identified as variables associated with hospital discharge. Conclusion These results show that clinical conditions such as comorbidities, urine output, and mechanical ventilation, and laboratory variables such as pH and CRP are factors associated with hospital discharge and AKRT discontinuation success, requiring larger studies for confirmation. Treatment for severe AKI involves the use of acute kidney replacement therapy (AKRT) to prevent or reverse complications. Factors predicting successful discontinuation of AKRT are unknown. We have shown clinical conditions as comorbidities, urine output and mechanical ventilation and laboratory variables as pH and CRP are factors predictors for hospital discharge and AKRT discontinuation success.