Predictive Factors for the Discontinuation of Renal Replacement Therapy in Critically Ill Adults: A Systematic Review and Meta-Analysis

Abstract

Acute kidney injury (AKI) is a decline in kidney function. Acute kidney injury frequently occurs as a complication among patients who are hospitalized or critically ill. Consequently, we aimed to examine the factors that could predict the cessation of renal replacement therapy (RRT) in individuals with severe AKI. We conducted a systematic review and meta-analysis with a comprehensive literature search in PubMed, Excerpta Medica database (Embase), and the Cochrane Library to identify relevant studies exploring factors associated with a successful transition from continuous renal replacement therapy (CRRT). The search was conducted from each database from beginning until December 1, 2022. The research was carried out on adult critically ill patients taking RRT while being supported in an intensive care unit (ICU) environment.We identified a total of 11 studies through our search. The pooled analysis demonstrated several predictive factors for successful weaning from CRRT, including CRRT duration, urine output in the course of CRRT termination (with an increase of 100 mL/day), creatinine clearance, urinary creatinine (UCr), neutrophil gelatinase-associated lipocalin (NGAL), and ICU length of stay (p < 0.00001). We concluded that the correlation between predictive factors and the weaning process from CRRT is not yet well understood. Furthermore, evidence is scarce concerning the optimal threshold values for UO and serum creatinine levels to determine successful weaning from CRRT. These findings provide valuable guidance to clinicians in determining the appropriate timing for discontinuing RRT in ICU settings.