Factors associated with failure to disconnect patients from continuous renal replacement therapy.

A single-center observational study.

Abstract

Introduction: Critically ill patients who survive a severe episode of Acute Kidney Injury (AKI) recover sufficient renal function to allow withdrawal of Renal Replacement Therapy (RRT). However, the criteria for deciding its withdrawal need to be standardized in clinical practice. The study aimed to determine the factors associated with failure to disconnect in patients on continuous renal replacement therapy.

Methods: This observational study was carried out in adult patients hospitalized in the intensive care service of the National Institute of Nutrition "Salvador Zubirán" in Mexico between October and December 2023 who required continuous renal replacement therapy. Retrospective data were collected, including demographic characteristics, comorbidities, type of renal replacement therapy, and clinical outcome. The SOFA score was used to assess disease severity.

Results: A total of 18 patients were analyzed, 14 with unsuccessful disconnection and 4 with successful disconnection, with an average stay of 14±8 days in the ICU; 72% were men, 44% with a history of diabetes, and 72.2% with a history of high blood pressure. A total of 94.4% with vasopressor requirement and invasive mechanical ventilation. The primary RRT modality was CVVHDF (88.9%). The main indications for initiation were overload (38.9%) and anuria (44.4%). There were no differences between population characteristics or RRT modality. Differences in mortality were evident, probably explained by the greater severity of the patients, as evidenced by the more excellent SOFA upon admission (P=0.001).

Conclusion: Patients who were unable to disconnect from the replacement therapy program had higher mortality. The factor that most contributed to this outcome was a higher SOFA score.