Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy

• Published in: Journal of critical care Vol. 27; no. 6; pp. 744.e1 - 744.e5
• Main Authors: Fröhlich, Stephen, MB, BCh, FRCA, Donnelly, Amy, MB, BCh, Solymos, Orsolya, MB, BCh, FCARCSI, Conlon, Niamh, MD, FCARCSI
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2012; Elsevier Limited
• Subjects: Age; Age Factors; Aged; Aged, 80 and over; Confidence intervals; Creatinine - metabolism; Creatinine clearance; Critical Care; Critical Illness; CRRT; Demographics; Dialysis; Female; Hemodialysis; Hospitals, Teaching; Humans; Intensive Care Units; Kidney diseases; Male; Middle Aged; Renal failure; Renal Replacement Therapy - methods; Retrospective Studies; Success; Teaching hospitals; Time Factors; Variables; Dialysis; Creatinine clearance; CRRT; Renal failure
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2012.08.012

Abstract Purpose A simple test that could guide successful cessation of continuous renal replacement therapy (CRRT) in critically ill patients would be clinically useful. This study aimed to investigate whether a 2-hour creatinine clearance (2h-CrCl) measurement could more accurately predict successful cessation of CRRT than serum creatinine or urine output alone. Materials and Methods This retrospective study identified all patients admitted to a university teaching hospital intensive care unit who received CRRT and had a 2h-CrCl measurement performed in the 12 hours preceding CRRT cessation. The ability of 2h-CrCl to predict successful discontinuation of CRRT was compared to other renal indices. Results Of 85 patients who had 2h-CrCl performed prior to CRRT cessation 53 (62.4%)(success group) remained dialysis free 7 days after CRRT cessation. 2h-CrCl was a better predictor of remaining CRRT free at day 7 (OR, 1.108 [1.05–1.17] per 1 mL/min increase in 2 hours CrCl, P < .001) than urine output, serum creatinine or age. A 2h-CrCl value of 23 mL/min had a sensitivity, specificity and positive predictive value for remaining CRRT free at day 7 of 75.5%, 84.4%, and 88.8%, respectively. Conclusion 2h-CrCl may be a useful measurement to help guide discontinuation from CRRT.