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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

Authors: Junseok Jeon, Do Hee Kim, Song In Baeg, Eun Jeong Lee, Chi Ryang Chung, Kyeongman Jeon, Jung Eun Lee, Wooseong Huh, Gee Young Suh, Yoon-Goo Kim, Dae Joong Kim, Ha Young Oh, Hye Ryoun Jang

Published in: Critical Care | Issue 1/2018

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Abstract

Background

Despite aggressive application of continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury (AKI), there is no consensus on diuretic therapy when discontinuation of CRRT is attempted. The effect of diuretics on discontinuation of CRRT in critically ill patients was evaluated.

Methods

This retrospective cohort study enrolled 1176 adult patients who survived for more than 3 days after discontinuing CRRT between 2009 and 2014. Patients were categorized depending on the re-initiation of renal replacement therapy within 3 days after discontinuing CRRT or use of diuretics. Changes in urine output (UO) and renal function after discontinuing CRRT were outcomes. Predictive factors for successful discontinuation of CRRT were also analyzed.

Results

The CRRT discontinuation group had a shorter duration of CRRT, more frequent use of diuretics after discontinuing CRRT, and greater UO on the day before CRRT discontinuation [day minus 1 (day − 1)]. The diuretics group had greater increases in UO and serum creatinine elevation after discontinuing CRRT. In the CRRT discontinuation group, continuous infusion of furosemide tended to increase UO more effectively. Multivariable regression analysis identified high day − 1 UO and use of diuretics as significant predictors of successful discontinuation of CRRT. Day − 1 UO of 125 mL/day was the cutoff value for predicting successful discontinuation of CRRT in oliguric patients treated with diuretics following CRRT.

Conclusions

Day − 1 UO and aggressive diuretic therapy were associated with successful CRRT discontinuation. Diuretic therapy may be helpful when attempting CRRT discontinuation in critically ill patients with AKI, by inducing a favorable fluid balance, especially in oliguric patients.
Literature
1.
2.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRefPubMed
3.
Andrikos E, Tseke P, Balafa O, Cruz DN, Tsinta A, Androulaki M, Pappas M, Ronco C. Epidemiology of acute renal failure in ICUs: a multi-center prospective study. Blood Purif. 2009;28:239–44.CrossRefPubMed
4.
Thakar CV, Christianson A, Freyberg R, Almenoff P, Render ML. Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study. Crit Care Med. 2009;37:2552–8.CrossRefPubMed
5.
Palevsky PM. Indications and timing of renal replacement therapy in acute kidney injury. Crit Care Med. 2008;36:S224–8.CrossRefPubMed
6.
Bellomo R, Ronco C. Indications and criteria for initiating renal replacement therapy in the intensive care unit. Kidney Int Suppl. 1998;66:S106–9.PubMed
7.
Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med. 2002;30:2051–8.CrossRefPubMed
8.
Vinsonneau C, Camus C, Combes A, Costa de Beauregard MA, Klouche K, Boulain T, Pallot JL, Chiche JD, Taupin P, Landais P, et al. Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet. 2006;368:379–85.CrossRefPubMed
9.
Lins RL, Elseviers MM, Van der Niepen P, Hoste E, Malbrain ML, Damas P, Devriendt J, investigators S. Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transplant. 2009;24:512–8.CrossRefPubMed
10.
Fieghen H, Wald R, Jaber BL. Renal replacement therapy for acute kidney injury. Nephron Clin Pract. 2009;112:c222–9.CrossRefPubMed
11.
Wu VC, Ko WJ, Chang HW, Chen YW, Lin YF, Shiao CC, Chen YM, Chen YS, Tsai PR, Hu FC, et al. Risk factors of early redialysis after weaning from postoperative acute renal replacement therapy. Intensive Care Med. 2008;34:101–8.CrossRefPubMed
12.
Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, et al. Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study. Crit Care Med. 2009;37:2576–82.CrossRefPubMed
13.
Heise D, Gries D, Moerer O, Bleckmann A, Quintel M. Predicting restoration of kidney function during CRRT-free intervals. J Cardiothorac Surg. 2012;7:6.CrossRefPubMedCentralPubMed
14.
Cantarovich F, Rangoonwala B, Lorenz H, Verho M, Esnault VL, High-Dose Flurosemide in Acute Renal Failure Study Group. High-dose furosemide for established ARF: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Am J Kidney Dis. 2004;44:402–9.CrossRefPubMed
15.
van der Voort PH, Boerma EC, Koopmans M, Zandberg M, de Ruiter J, Gerritsen RT, Egbers PH, Kingma WP, Kuiper MA. Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit Care Med. 2009;37:533–8.CrossRefPubMed
16.
Bagshaw SM, Delaney A, Haase M, Ghali WA, Bellomo R. Loop diuretics in the management of acute renal failure: a systematic review and meta-analysis. Crit Care Resusc. 2007;9:60–8.PubMed
17.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.CrossRefPubMedCentralPubMed
18.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179–84.PubMed
19.
Neri M, Villa G, Garzotto F, Bagshaw S, Bellomo R, Cerda J, Ferrari F, Guggia S, Joannidis M, Kellum J, et al. Nomenclature for renal replacement therapy in acute kidney injury: basic principles. Crit Care. 2016;20:318.CrossRefPubMedCentralPubMed
20.
Delannoy B, Floccard B, Thiolliere F, Kaaki M, Badet M, Rosselli S, Ber CE, Saez A, Flandreau G, Guerin C. Six-month outcome in acute kidney injury requiring renal replacement therapy in the ICU: a multicentre prospective study. Intensive Care Med. 2009;35:1907–15.CrossRefPubMed
21.
Investigators RRTS, Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, McArthur C, McGuinness S, Myburgh J, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361:1627–38.CrossRef
22.
Rondon-Berrios H, Palevsky PM. Treatment of acute kidney injury: an update on the management of renal replacement therapy. Curr Opin Nephrol Hypertens. 2007;16:64–70.CrossRefPubMed
23.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.CrossRef
24.
Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL, Program to Improve Care in Acute Renal Disease Study Group. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76:422–7.CrossRefPubMed
25.
Bambauer R. New approaches in the treatment of acute kidney injury. Ther Apher Dial. 2009;13:248–53.CrossRefPubMed
26.
Gibney N, Hoste E, Burdmann EA, Bunchman T, Kher V, Viswanathan R, Mehta RL, Ronco C. Timing of initiation and discontinuation of renal replacement therapy in AKI: unanswered key questions. Clin J Am Soc Nephrol. 2008;3:876–80.CrossRefPubMed
27.
Oh HJ, Shin DH, Lee MJ, Ko KI, Kim CH, Koo HM, Doh FM, Kwon YE, Kim YL, Nam KH, et al. Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy. J Crit Care. 2013;28:379–88.CrossRefPubMed
28.
29.
Ronco C, Ricci Z, De Backer D, Kellum JA, Taccone FS, Joannidis M, Pickkers P, Cantaluppi V, Turani F, Saudan P, et al. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care. 2015;19:146.CrossRefPubMedCentralPubMed
30.
Golper TA, Cigarran-Guldris S, Jenkins RD, Brier ME. The role of convection during simulated continuous arteriovenous hemodialysis. Contrib Nephrol. 1991;93:146–8.CrossRefPubMed
31.
Chawla LS, Davison DL, Brasha-Mitchell E, Koyner JL, Arthur JM, Shaw AD, Tumlin JA, Trevino SA, Kimmel PL, Seneff MG. Development and standardization of a furosemide stress test to predict the severity of acute kidney injury. Crit Care. 2013;17:R207.CrossRefPubMedCentralPubMed
32.
Palevsky PM, Zhang JH, O'Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.CrossRefPubMed
33.
Vargas Hein O, Staegemann M, Wagner D, von Heymann C, Martin M, Morgera S, Spies C. Torsemide versus furosemide after continuous renal replacement therapy due to acute renal failure in cardiac surgery patients. Ren Fail. 2005;27:385–92.CrossRefPubMed
34.
Karajala V, Mansour W, Kellum JA. Diuretics in acute kidney injury. Minerva Anestesiol. 2009;75:251–7.PubMed
35.
Mason J, Kain H, Welsch J, Schnermann J. The early phase of experimental acute renal failure. VI. The influence of furosemide. Pflugers Arch. 1981;392:125–33.CrossRefPubMed
36.
Koyner JL, Davison DL, Brasha-Mitchell E, Chalikonda DM, Arthur JM, Shaw AD, Tumlin JA, Trevino SA, Bennett MR, Kimmel PL, et al. Furosemide stress test and biomarkers for the prediction of AKI severity. J Am Soc Nephrol. 2015;26:2023–31.CrossRefPubMedCentralPubMed
37.
Palevsky PM, Baldwin I, Davenport A, Goldstein S, Paganini E. Renal replacement therapy and the kidney: minimizing the impact of renal replacement therapy on recovery of acute renal failure. Curr Opin Crit Care. 2005;11:548–54.CrossRefPubMed
38.
Pepin MN, Bouchard J, Legault L, Ethier J. Diagnostic performance of fractional excretion of urea and fractional excretion of sodium in the evaluations of patients with acute kidney injury with or without diuretic treatment. Am J Kidney Dis. 2007;50:566–73.CrossRefPubMed
Metadata
Title
Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury
Authors
Junseok Jeon
Do Hee Kim
Song In Baeg
Eun Jeong Lee
Chi Ryang Chung
Kyeongman Jeon
Jung Eun Lee
Wooseong Huh
Gee Young Suh
Yoon-Goo Kim
Dae Joong Kim
Ha Young Oh
Hye Ryoun Jang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2192-9

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