Dados do Trabalho

Título

DEVELOPMENT OF A DECISION-MAKING ALGORITHM IN THE DEVELOPING WORLD FOR ACUTE KIDNEY REPLACEMENT THERAPY SUCCESSFUL DISCONTINUATION IN CRITICALLY ILL PATIENTS: THE NEED FOR CONSENSUS IN BRAZIL

Introdução

Recovery of kidney function to liberate patients from Acute kidney replacement therapy (AKRT) is recognized as a vital patient-centred outcome. The lack consensus and guidelines providing specific recommendations on therapy interruption is an importante obstacle. We aimed to determine the prevalence of successful discontinuation of AKRT and its predictive factors after the elaboration of clinical protocol with these recommendations.

Material e Método

After the elaboration and aplication of a protocol for AKRT discontinuation based on the results of a previous retrospective study held in our service and on the existing evidence in the literature, we developed a prospective cohort study. Discontinuation success was defined as not needing to resume dialysis treatment within 10 days after interruption. The study was performed at a public Brazilian university hospital between July 2020 and July 2021, including patients > 18 years requiring AKRT which had their therapy discontinued during hospital stay. Chi-Square Test was used to compare categorical variables and the t Test for the continuous variables if normally distributed or Mann Whitney if non-normally distributed. In all tests performed, a significance level of 5% was considered.

Resultados

Success discontinuation and hospital discharge were achieved for most patients (84.6% and 89%, respectively). Multivariable logistic regression analysis showed that C reactive protein (CRP), urine output and creatinine clearance at the time of interruption were variable associated with discontinuation success (OR 0.943, CI 0.905– 0.983, p=0.006; OR1.078, CI1.008–1.173, p=0.009 and OR1.091, CI1.012–1.213, p=0.004; respectively). The areas under the curve for CRP, urine output and creatinine clearance at the time of interruption were 0.78, 0.62 and 0.82, respectively. Both CRP and creatinine clearance were good predictors of successful liberation of AKRT. The optimal cutoff value of them had sensitivity and specificity of 0.88 and 0.87, 0.91 and 0.90, respectively. The use of noradrenalin at the time of interruption (OR0.143, CI0.047–0.441, p=0.001) and successful discontinuation (OR3.745, CI1.047–13.393, p=0.042) were identified as variables associated with hospital discharge.

Discussão e Conclusões

Our results show the factors related to success in discontinuing AKRT are the CRP, creatinine clearance and urinary output at the time of AKRT interruption. Successful interruption of AKRT e absence o VAD at the time of interruption were associated with lower mortality.

Palavras Chave

acute kidney injury; acute kidney replacement therapy; discontinuation; success; interruption criteria; predictive factors