Kidney Res Clin Pract.
2024 Jul;43(4):528-537. 10.23876/j.krcp.23.308.
Validation of prediction model for successful discontinuation of continuous renal replacement therapy: a multicenter cohort study
- Affiliations
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- 1Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- 2Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Bucheon St. Mary’s Hospital, Bucheon, Republic of Korea
- 3Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- 4Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Goyang, Republic of Korea
- 5Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Republic of Korea
- 6Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary’s Hospital, Seoul, Republic of Korea
- 7Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
- KMID: 2557333
- DOI: http://doi.org/10.23876/j.krcp.23.308
Abstract
- Background
Continuous renal replacement therapy (CRRT) has become the standard modality of renal replacement therapy (RRT) in critically ill patients. However, consensus is lacking regarding the criteria for discontinuing CRRT. Here we validated the usefulness of the prediction model for successful discontinuation of CRRT in a multicenter retrospective cohort. Methods: One temporal cohort and four external cohorts included 1,517 patients with acute kidney injury who underwent CRRT for >2 days from 2018 to 2020. The model was composed of four variables: urine output, blood urea nitrogen, serum potassium, and mean arterial pressure. Successful discontinuation of CRRT was defined as the absence of an RRT requirement for 7 days thereafter. Results: The area under the receiver operating characteristic curve (AUROC) was 0.74 (95% confidence interval, 0.71–0.76). The probabilities of successful discontinuation were approximately 17%, 35%, and 70% in the low-score, intermediate-score, and highscore groups, respectively. The model performance was good in four cohorts (AUROC, 0.73–0.75) but poor in one cohort (AUROC, 0.56). In one cohort with poor performance, attending physicians primarily controlled CRRT prescription and discontinuation, while in the other four cohorts, nephrologists determined all important steps in CRRT operation, including screening for CRRT discontinuation. Conclusion: The overall performance of our prediction model using four simple variables for successful discontinuation of CRRT was good, except for one cohort where nephrologists did not actively engage in CRRT operation. These results suggest the need for active engagement of nephrologists and protocolized management for CRRT discontinuation.
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