Kidney Week

Abstract: FR-PO095

Urine Output at Continuous Kidney Replacement Therapy Discontinuation Predicts 1-Year Mortality and Kidney Outcome in Critically Ill Patients with AKI

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Kim, Sungmi, The Catholic University of Korea Eunpyeong St Mary's Hospital, Eunpyeong-gu, Seoul, Korea (the Republic of)

Sungmi Kim, MD

• Min, Ji Won, The Catholic University of Korea Bucheon St Mary's Hospital, Bucheon, Gyeonggi-do, Korea (the Republic of)

Ji Won Min, MD, PhD

• Ko, Eun jeong, The Catholic University of Korea Bucheon St Mary's Hospital, Bucheon, Gyeonggi-do, Korea (the Republic of)

Eun jeong Ko, MD, PhD

• Koh, Eun Sil, The Catholic University of Korea Yeouido Saint Mary's Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)

Eun Sil Koh, MD, PhD

• Kim, Hyung Duk, The Catholic University of Korea Eunpyeong St Mary's Hospital, Eunpyeong-gu, Seoul, Korea (the Republic of)

Hyung Duk Kim, MD

• Chung, Byung ha, The Catholic University of Korea Seoul St Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)

Byung ha Chung, MD, PhD

• Hong, Yu Ah, The Catholic University of Korea Daejeon St Mary's Hospital, Daejeon, Korea (the Republic of)

Yu Ah Hong, MD, PhD

Background

Continuous renal replacement therapy (CRRT) is crucial for managing critically ill patients with acute kidney injury (AKI). However, the prognostic indicators for long-term prognosis after CRRT, especially present in the early stage of AKI, remain unclear. This study aimed to identify predictors of long-term clinical outcomes in patients with severe AKI, focusing on urine output (UO) at CRRT discontinuation.

Methods

This retrospective study included 851 AKI patients undergoing CRRT at three tertiary hospitals. Patients were categorized into four groups based on 24-hour UO at CRRT discontinuation. We analyzed one-year all-cause mortality and the development of end-stage kidney disease (ESKD).

Results

During one year after CRRT discontinuation, 333 (39.1%) of 851 patients died, and 150 (30.1%) of 499 patients progressed to ESKD. In multivariable analysis, UO was inversely associated with the risks of all-cause mortality (UO <100 ml/day: hazard ratio [HR] 3.08, 95% confidence interval [CI] 2.23–4.26, P < 0.01; UO 100–499.9 ml/day: HR 2.25, 95% CI 1.58–3.19, P < 0.01; UO 500–1499.9 ml/day: HR 1.71, 95% CI 1.18–2.47, P < 0.01), and the development of ESKD (UO <100 ml/day: odd ratio [OR] 16.17, 95% CI 7.67–34.09, P < 0.01; UO 100–499.9 ml/day: OR 7.50, 95% CI 3.48–16.18, P < 0.01; UO 500–1499.9 ml/day: OR 3.40, 95% CI 1.54–7.48, P < 0.01) when using UO ≥1500 ml/day as the reference category. There were linear relationships between UO and the risks of ESKD (P for nonlinearity = 0.07) and mortality (P for nonlinearity = 0.22) throughout a wide range of UO. Though diuretics use was not associated with ESKD risk and did not affect the association between UO and ESKD risk, UO remained significantly predictive of the risk of ESKD irrespective of diuretics use.

Conclusion

This study underscores the importance of monitoring UO in predicting long-term risks of ESKD and mortality in critically ill AKI patients undergoing CRRT.