Factors Related To Predicting Successful Discontinuation Of Continuous Renal Replacement Therapy

Objective: The purpose of this study was to investigate the related factors of successful discontinuation of continuous renal replacement therapy in acute kidney injury patients.Methods: This study retrospectively analyzed the patients who were admitted to the Intensive Care Unit of the Fourth Hospital of Hebei Medical University from October 2015 to July 2020.They had no underlying renal disease and received Continuous Renal Replacement Therapy.Clinical data of Acute Kidney Injury(AKI)patients.Patients were diagnosed with AKI according to the criteria for improving the prognosis of kidney disease(KDIGO).Record the age,height,weight,body mass index,gender,and previous renal function(estimated glomerular filtration rate-e GFR based on the epidemiology of chronic kidney disease)and other basic information of patients who meet the selection criteria.And CRRT shutdown related data:central venous pressure(CVP),creatinine,urea,fluid balance,record the4-hour,6-hour,and 24-hour urine output before and after CRRT stops,and the daily urine output after shutdown.According to whether CRRT treatment was performed again within 7days after the shutdown,the patients were divided into "successful shutdown group" and "shutdown failure group ".Results: Finally,126 patients with AKI meeting the criteria were screened out,and a total of 172 shutdown experiments were performed,including 98 cases in the successful shutdown group and 74 cases in the failed shutdown group.There was no statistically significant difference in baseline characteristic levels between the two groups.Through multiple logistic regression analysis,creatinine on the first day(D1)after getting off the plane,creatinine on the second day after getting off the plane/the day of stopping(D2/D0),urine output 24 h after getting off the plane,D1-CVP and CRRT after getting off the plane were successful downtime related.Through receiver operating characteristic curve(ROC)analysis,it is predicted that the area under the receiver operating characteristic curve(AUC-ROC)at 24 hours after CRRT is successfully shut down is 0.774,The best cutoff value is 1445.5ml,the sensitivity and specificity are 76%,the AUC-ROC of the diuretic group is 0.719,the cutoff value is 1246.5ml,and the diuretic group is 0.909,the cutoff value is 1445.5ml,there is a statistical difference between the two groups of ROC curves,P=0.01.After disembarking,D1 creatinine AUC-ROC is 0.742,cutoff value is 44.5umol/L,sensitivity is 72%,specificity is 75%,D2/D0 creatinine AUC-ROC is 0.703,cutoff value is 0.455,sensitivity is 66 %,specificity is 70%,D1-CVP AUC-ROC is 0.807,cutoff value is 8,sensitivity is 80%,specificity is 84%.Conclusions: D1 creatinine after getting off the machine,D2/D0 creatinine after getting off the machine,urine output 24 h after getting off the machine,and D1-CVP after getting off the machine are related factors for the successful shutdown of CRRT.The use of diuretics will affect the accuracy of urine output to predict CRRT shutdown.