Kidney Week

Abstract: TH-PO229

Development of a Novel Protocol for Successful Discontinuation of Continuous Kidney Replacement Therapy: A Pilot Study

Session Information

• Hemodialysis, Hemodiafiltration, and Frequent Dialysis
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Song, Daun, Konyang University Hospital, Daejeon, Korea (the Republic of)

Daun Song, MD

• Lee, Ji won, Konyang University Hospital, Daejeon, Korea (the Republic of)

Ji won Lee, MD

• Yoon, Se-Hee, Konyang University Hospital, Daejeon, Korea (the Republic of)

Se-Hee Yoon, MD, PhD

• Hwang, Won Min, Konyang University Hospital, Daejeon, Korea (the Republic of)

Won Min Hwang, MD, PhD

• Yun, Sung-Ro, Konyang University Hospital, Daejeon, Korea (the Republic of)

Sung-Ro Yun, MD, PhD

• Lee, Sua, Daejeon Eulji University Hospital, Daejeon, Korea (the Republic of)

Sua Lee, MD

• Lee, Soyoung, Daejeon Eulji University Hospital, Daejeon, Korea (the Republic of)

Soyoung Lee, MD

• Park, Yohan, Konyang University Hospital, Daejeon, Korea (the Republic of)

Yohan Park, MD

Group or Team Name

• Div of Nephrology, Dept of Internal Medicine, Konyang University Hospital; Div of Nephrology, Dept of Internal Medicine, Daejeon Eulji Medical Center.

Background

The discontinuation of continuous kidney replacement therapy (CKRT) lacks a well-established protocol. Creatinine and cystatin C (CysC) are well-known markers of kidney function, with molecular weights of 113 Da and 13.3 kDa, respectively. This study aimed to develop a novel CKRT discontinuation protocol by predicting kidney function using changes in serum cystatin C (CysC) levels after switching the CKRT mode to continuous veno-venous hemodialysis (CVVHD), which has a lower clearance rate for middle molecular weight solutes.

Methods

This pilot study included 17 patients undergoing CKRT. Patients who maintained stable vital signs without vasopressor support were switched from continuous veno-venous hemodiafiltration (CVVHDF) to CVVHD. Serum creatinine and CysC levels were measured at 6, 12, and 24 hours after switching to CVVHD mode, along with daily urine output. Kidney replacement therapy (KRT) reinitiation was defined as the resumption of KRT within 7 days after discontinuing CKRT.

Results

Out of 17 patients, 7 experienced KRT reinitiation. Following the switch to CVVHD mode, serum creatinine levels remained stable or decreased in all patients, whereas an increase in serum CysC was observed in the KRT reinitiated group. Receiver operating characteristic (ROC) curve analysis was conducted to predict KRT reinitiation. The 12hr CysC to baseline CysC ratio had the highest area under the ROC curve (AUROC) value of 0.857, with a cutoff value of 0.97. The AUROC value for daily urine output was 0.871, with a cutoff value of 214 mL. A multivariate model incorporating both the 12hr CysC to baseline CysC ratio and daily urine output demonstrated an AUROC value of 0.986, showing exceptional predictive performance for KRT reinitiation.

Conclusion

The multivariate model using the 12hr CysC change and daily urine output after switching to CVVHD mode proved to be an excellent predictor of KRT reinitiation. Based on this pilot study, a CKRT discontinuation protocol could be developed, and if validated in larger studies, may lead to a paradigm shift in CKRT discontinuation practices.