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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients

Authors: Julien Aniort, Ali Ait Hssain, Bruno Pereira, Elisabeth Coupez, Pierre Antoine Pioche, Christophe Leroy, Anne Elisabeth Heng, Bertrand Souweine, Alexandre Lautrette

Published in: Critical Care | Issue 1/2016

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Abstract

Background

There are no easily available markers of renal recovery to guide intermittent hemodialysis (IHD) weaning. The aim of this study was to identify markers for IHD weaning in critically ill patients with acute kidney injury (AKI).

Methods

We performed a retrospective single-center cohort study of patients treated with IHD for at least 7 days and four dialysis sessions for AKI between 2006 and 2011 in an intensive care unit (ICU) of a French university hospital. Blood and urinary markers were recorded on the day of the last IHD in the ICU for unweaned patients and 2 days after the last IHD for weaned patients. Factors associated with IHD weaning were identified by multiple logistic regression. The areas under the receiver operating characteristic curve (AUROC) and the characteristics of the best diagnostic thresholds were compared.

Results

Sixty-seven patients were analyzed, including thirty-seven IHD-weaned patients. Urine output [odds ratio (OR) 1.59, 95 % confidence interval (CI) 1.20–2.10 (per ml/kg/24 h increase); P = 0.01] and urinary urea concentration [OR 1.29, 95 % CI 1.01–1.64 (per 10 mmol/L increase); P = 0.04] were both associated with IHD weaning. The optimal diagnostic thresholds for IHD weaning were urine output greater than 8.5 ml/kg/24 h, urinary urea concentration greater than 148 mmol/L, and daily urea excretion greater than 1.35 mmol/kg/24 h, with accuracy of 82.1 %, 76.1 %, and 92.5 % (P = 0.03), respectively. The AUROC of daily urinary urea excretion (0.96) was greater than the AUROC of urine output (0.86) or the AUROC of urinary urea concentration (0.83) (P < 0.001).

Conclusions

A daily urinary urea excretion greater than 1.35 mmol/kg/24 h was found to be the best marker for weaning ICU patients with AKI from IHD.
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Literature
1.
van de Wetering J, Westendorp RG, van der Hoeven JG, Stolk B, Feuth JD, Chang PC. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol. 1996;7(1):145–50.PubMed
2.
Silversides JA, Pinto R, Kuint R, Wald R, Hladunewich MA, Lapinsky SE, et al. Fluid balance, intradialytic hypotension, and outcomes in critically ill patients undergoing renal replacement therapy: a cohort study. Crit Care. 2014;18:624.CrossRefPubMedPubMedCentral
3.
Roberts DM, Roberts JA, Roberts MS, Liu X, Nair P, Cole L, et al. Variability of antibiotic concentrations in critically ill patients receiving continuous renal replacement therapy: a multicentre pharmacokinetic study. Crit Care Med. 2012;40(5):1523–8.CrossRefPubMed
4.
Klein CJ, Moser-Veillon PB, Schweitzer A, Douglass LW, Reynolds HN, Patterson KY, et al. Magnesium, calcium, zinc, and nitrogen loss in trauma patients during continuous renal replacement therapy. JPEN J Parenter Enteral Nutr. 2002;26(2):77–93.CrossRefPubMed
5.
Hoste EA, Blot SI, Lameire NH, Vanholder RC, De Bacquer D, Colardyn FA. Effect of nosocomial bloodstream infection on the outcome of critically ill patients with acute renal failure treated with renal replacement therapy. J Am Soc Nephrol. 2004;15(2):454–62.CrossRefPubMed
6.
Elseviers MM, Lins RL, Van der Niepen P, Hoste E, Malbrain ML, Damas P, et al. Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care. 2010;14:R221.CrossRefPubMedPubMedCentral
7.
Schortgen F, Soubrier N, Delclaux C, Thuong M, Girou E, Brun-Buisson C, et al. Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med. 2000;162(1):197–202.CrossRefPubMed
8.
Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KE, Garg AX, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2015;65(6):870–7.CrossRefPubMed
9.
10.
Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20.CrossRefPubMed
11.
Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627–38.CrossRefPubMed
12.
13.
Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15:R72.CrossRefPubMedPubMedCentral
14.
Jun M, Bellomo R, Cass A, Gallagher M, Lo S, Lee J. Timing of renal replacement therapy and patient outcomes in the randomized evaluation of normal versus augmented level of replacement therapy study. Crit Care Med. 2014;42(8):1756–65.CrossRefPubMed
15.
Wald R, Adhikari NK, Smith OM, Weir MA, Pope K, Cohen A, et al. Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury. Kidney Int. 2015;88(4):897–904.CrossRefPubMed
16.
Frohlich S, Donnelly A, Solymos O, Conlon N. Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy. J Crit Care. 2012;27(6):744. e1–e5.CrossRefPubMed
17.
Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med. 2009;37(9):2576–82.CrossRefPubMed
18.
Wu VC, Ko WJ, Chang HW, Chen YW, Lin YF, Shiao CC, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med. 2008;34(1):101–8.CrossRefPubMed
19.
Srisawat N, Lawsin L, Uchino S, Bellomo R, Kellum JA, BEST Kidney Investigators. Cost of acute renal replacement therapy in the intensive care unit: results from The Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) study. Crit Care. 2010;14:R46.CrossRefPubMedPubMedCentral
20.
Parienti JJ, Dugue AE, Daurel C, Mira JP, Megarbane B, Mermel LA, et al. Continuous renal replacement therapy may increase the risk of catheter infection. Clin J Am Soc Nephrol. 2010;5(8):1489–96.CrossRefPubMedPubMedCentral
21.
Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013;41(6):1543–54.CrossRefPubMed
22.
Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137–47.CrossRefPubMed
23.
Pannu N, James M, Hemmelgarn B, Klarenbach S, Alberta Kidney Disease Network. Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2013;8(2):194–202.CrossRefPubMedPubMedCentral
24.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.CrossRefPubMed
25.
26.
Dantzler WH, Layton AT, Layton HE, Pannabecker TL. Urine-concentrating mechanism in the inner medulla: function of the thin limbs of the loops of Henle. Clin J Am Soc Nephrol. 2014;9(10):1781–9.CrossRefPubMedPubMedCentral
27.
Knepper MA, Kwon TH, Nielsen S. Molecular physiology of water balance. N Engl J Med. 2015;372(14):1349–58.CrossRefPubMed
28.
Schneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M, et al. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med. 2013;39(6):987–97.CrossRefPubMed
29.
Sun Z, Ye H, Shen X, Chao H, Wu X, Yang J. Continuous venovenous hemofiltration versus extended daily hemofiltration in patients with septic acute kidney injury: a retrospective cohort study. Crit Care. 2014;18:R70.CrossRefPubMedPubMedCentral
30.
Wald R, Shariff SZ, Adhikari NK, Bagshaw SM, Burns KE, Friedrich JO, et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study. Crit Care Med. 2014;42(4):868–77.CrossRefPubMed
Metadata
Title
Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients
Authors
Julien Aniort
Ali Ait Hssain
Bruno Pereira
Elisabeth Coupez
Pierre Antoine Pioche
Christophe Leroy
Anne Elisabeth Heng
Bertrand Souweine
Alexandre Lautrette
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1225-5

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