Introduction
Methods
Search strategy
Study selection
Eligibility criteria
Risk of bias assessment
Data analysis
Results
Search results
Study | Study type | Population | #Patients with discontinuation of RRT | Quality (NOS) | Parameters identified | Definition of weaning success |
---|---|---|---|---|---|---|
Chen et al. [19] | Prospective cohort | Adult patients receiving CRRT | 78 | 9 | Urine output, plasma NGAL, serum Cr at discontinuation | Survival with no requirement for RRT within 7 days |
Yoshida et al. [17] | Retrospective cohort | General ICU patients requiring RRT | 38 | 8 | Serum Cr, urine output, eGFR, kinetic eGFR at discontinuation | Survival off CRRT × 48 h, off IHD for 7 days |
Jeon et al. [37] | Retrospective cohort | Adult patients with AKI on CRRT | 517 | 9 | Urine output, multivariate model at discontinuation | Survival with no re-initiation of RRT within 3 days |
Itenov et al. [38] | Prospective cohort | Adult patients with AKI | 719 | 8 | Multivariate model | Survival with no re-initiation of RRT for 5 days |
Kim et al. [28] | Prospective cohort | ICU patients weaned from CRRT | 89 | 8 | Serum cystatin C, plasma NGAL, urine output | Survival with no re-initiation of RRT for 14 days |
Raurich et al. [27] | Retrospective cohort | ICU patients requiring CRRT who underwent weaning tests | 67 | 9 | Urine output with/without diuretics, multivariate model | Urine output recovered, RRT not required |
Romero-Gonzalez et al. [39] | Retrospective cohort | Patients with AKI treated with CRRT | 37 | – | Urine output | Independence from RRT 14 days after discontinuation |
Yang et al. [29] | Retrospective cohort | ICU patients weaned from CRRT, PIRRT, IHD | 302 | 7 | Serum cystatin C | Survival with no requirement for RRT 30 days after discharge |
Yang et al. [30] | Prospective observational study | ICU patients who weaned from CRRT | 102 | 7 | Serum cystatin C | Survival at 60 days with Cr no more than 1.5X baseline |
Aniort et al. [25] | Retrospective cohort | ICU patients receiving IHD for at least 7 days | 67 | 8 | Daily urine urea, eUrea, urine output | No requirement for further dialysis sessions during ICU stay |
Katayama et al. [22] | Retrospective cohort | General ICU patients receiving CRRT | 116 | 8 | Urine output, Cr | Survival with no re-initiation of CRRT for 7 days |
Han et al. [18] | Retrospective cohort | General ICU patients requiring CRRT | 160 | 7 | Multivariate model, Cr | Complete or partial recovery of AKI within 2 weeks |
Kim et al. [40] | Prospective cohort | General ICU patients requiring RRT | 89 | 4 | Cystatin C-based eGFR | Survival with no re-initiation of RRT for 14 days |
Viallet et al. [26] | Retrospective cohort | Adult patients who received CRRT, IHD or SLED and survived ICU stay | 26 | 7 | Urine output, urine Cr | Cessation of RRT for at least 15 days |
Gleeson et al. [23] | Retrospective cohort | General ICU patients requiring RRT | 67 | 6 | Residual creatinine clearance | Not specified |
Ohnuma et al. [41] | Retrospective cohort | General ICU patients requiring CRRT or IHD | 109 | 5 | Urine output | Free from RRT for 7 days after discontinuation |
Frohlich et al. [20] | Retrospective cohort | General ICU patients requiring CRRT | 53 | 6 | 2 h CrCl, Cr, urine output at discontinuation | Free from RRT for 7 days after discontinuation |
Heise [42] | Retrospective cohort | Surgical ICU patients requiring CRRT | 222 | 9 | Multivariate model | Discharged from ICU with no further RRT during hospital stay |
Zhang et al. [31] | Retrospective cohort | General ICU patients requiring CRRT | 145 | 8 | Serum cystatin C | Survivors who were not dependent on RRT |
Solymos [43] | Retrospective cohort | General ICU patients requiring CRRT | 23 | 6 | 2 h CrCl | Free from RRT for 5 days after discontinuation |
Franzen et al. [44] | Retrospective cohort | Medical ICU patients requiring IHD | 20 | 7 | IHD ultrafiltration | No need for long-term RRT |
Uchino et al. [21] | Prospective cohort | General ICU patients requiring CRRT | 313 | 7 | Urine output, Cr | Free from RRT for 7 days after discontinuation |
Wu et al. [45] | Case control | Surgical ICU patients requiring CRRT or IHD | 64 | 7 | Multivariate model | Free from RRT for 30 days after discontinuation |
Study quality
Markers of RRT weaning
Test/parameter | Value/cut-off | Timing | RRT modality | Sn | Sp | OR | AUROC | Publication |
---|---|---|---|---|---|---|---|---|
Serum creatinine | ||||||||
299.68 umol/L | Initiation | CRRT | 0.79 | 0.79 | 0.75 | Yoshida et al. [17] | ||
Not specified | Initiation | CRRT | 0.59 | Han et al. [18] | ||||
224 umol/L | Discontinuation | CRRT | 0.72 | 0.77 | 0.76 | Chen et al. [19] | ||
Per umol/L increase | Discontinuation | CRRT | 0.48 | Frohlich et al. [20] | ||||
Not specified | Discontinuation | CRRT | 0.64 | Uchino et al. [21] | ||||
Not specified | Discontinuation | CRRT | 0.73 | Katayama et al. [22] | ||||
2-h creatinine clearance | ||||||||
23 mL/min | 12 h pre-stop | Not specified | 1.11 | 0.82 | Frohlich et al. [20] | |||
Residual creatinine clearance | ||||||||
Not specified | 24–48 h pre-stop | Not specified | 0.90 | Gleeson et al. [23] | ||||
Kinetic eGFR | ||||||||
20.58 mL/min/1.73 m2 | Discontinuation | CRRT | 0.71 | 0.92 | 0.87 | Yoshida et al. [17] | ||
eGFR | ||||||||
26.21 mL/min/1.73 m2 | D1 post-stop | CRRT | 0.71 | 0.85 | 0.83 | Yoshida et al. [17] | ||
24 h urine creatinine | ||||||||
> 5.2 mol/24 h | D0 post-stop | CRRT, SLED, | 0.57 | 0.96 | 0.76 | Viallet et al. [26] | ||
D1 | IHD | 0.75 | 0.88 | 0.86 | ||||
D2 | 0.86 | 0.81 | 0.86 | |||||
Urine urea | ||||||||
> 148 mmol/L | Discontinuation | IHD, CRRT | 0.65 | 0.90 | 0.82 | Aniort et al. [25] | ||
Daily urinary urea excretion | ||||||||
> 1.35 mmol/kg/day | Discontinuation | IHD, CRRT | 0.89 | 0.97 | 0.96 | Aniort et al. [25] |
Test/parameter | Value/cut-off | Timing | RRT modality | Sn | Sp | OR | AUROC | Publication |
---|---|---|---|---|---|---|---|---|
Serum cystatin C | ||||||||
2.47 mg/L | Initiation | CRRT | 0.95 | 0.54 | 0.75 | Yang et al. [30] | ||
2.98 mg/L | ICU admission | CRRT | 0.81 | 0.84 | 4.76 | 0.87 | Zhang et al. [31] | |
2.97 mg/L | Discontinuation | CRRT | 0.80 | 0.58 | 0.71 | Yang et al. [30] | ||
1.85 mg/L | Discontinuation | CRRT | 0.76 | 0.63 | 0.29 | 0.74 | Kim et al. [28] | |
Not specified | Discontinuation | CRRT | 0.74 | Yang et al. [29] | ||||
Cystatin C-based eGFR | ||||||||
32.9 mL/min/1.73m2 | Discontinuation | CRRT | 0.65 | 0.76 | 1.25 | 0.75 | Kim et al. [40] | |
NT-proBNP | ||||||||
> 15,767 | Initiation | CRRT | 0.54 | 0.58 | Han et al. [18] | |||
NGAL | ||||||||
Not specified | Discontinuation | CRRT | 0.91 | 0.45 | 0.65 | Kim et al. [28] | ||
403 ng/mL | Discontinuation | CRRT | 0.91 | 0.61 | 0.81 | Chen et al. [19] | ||
Not specified | Discontinuation | CRRT | 0.66 | Yang et al. [30] | ||||
IL-18 | ||||||||
Not specified | Discontinuation | CRRT | 0.60 | Yang et al. [30] | ||||
IL-6 | ||||||||
Not specified | Discontinuation | CRRT | 0.55 | Yang et al. [30] | ||||
Serum osteopontin | ||||||||
Not specified | Discontinuation | CRRT | 0.61 | Yang et al. [30] |
Study | Cut-off value | # Patients | Sensitivity | Specificity | AUROC |
---|---|---|---|---|---|
Aniort et al. [25] | > 8.6 mL/kg/24 h | 67 | 0.89 | 0.73 | 0.86 |
Gleeson et al. [23] | Not specified | 157 | Not estimable | Not estimable | 0.87 |
Katayama et al. [22] | 100 mL/day increase | 213 | Not estimable | Not estimable | 0.81 |
Kim et al. [28] | > 1.26 mL/kg/h | 110 | 0.60 | 0.67 | 0.67 |
Uchino et al. [21] | > 400 mL/day (no diuretics) | 1006 | 0.46 | 0.81 | 0.85 |
Yoshida et al. [17] | > 1720 mL/24 h | 52 | 0.68 | 0.86 | 0.78 |
Chen et al. [19] | > 715 mL/24 h | 110 | 0.83 | 0.87 | 0.85 |
Jeon et al. [37] | > 191 mL/24 h | 557 | 0.81 | 0.72 | 0.82 |
Romero-Gonzalez et al. [39] | > 720 mL/24 h | 77 | Not estimable | Not estimable | 0.80 |
POOLED | 0.66 (0.54, 0.77) | 0.77 (0.71, 0.83) 0.74 (0.68, 0.79) | |||
LR(−) 0.43 | LR(+) 2.91 |
Study | Cut-off value | # Patients | Sensitivity | Specificity | AUROC |
---|---|---|---|---|---|
Raurich et al. [27] | > 178 mL in the 6 h post-discontinuation | 86 | 0.90 | 0.89 | 0.91 |
Viallet [26] | > 2575 mL/24 h post-discontinuation | 54 | 0.38 | 0.93 | 0.65 |
Yoshida et al. [17] | > 1709 mL/24 h post-discontinuation | 52 | 0.76 | 0.79 | 0.77 |
Han et al. [18] | Not specified | 160 | Not estimable | Not estimable | 0.63 |
Study | Cutoff Value | # Patients | Sensitivity (95% CI) | Specificity (95% CI) | AUROC (95% CI) |
---|---|---|---|---|---|
Jeon et al., diuretics [37] | 191 mL/day | 557 | 81.2 (77.6, 84.5) | 71.6 (68.0, 75.0) | 0.821 (0.797, 0.845) |
Jeon et al., diuretics (oliguric) [37] | 125 mL/day | 619 | 72.1 (64.6, 78.8) | 68.8 (61.3, 75.7) | 0.745 (0.692, 0.798) |
Raurich et al., no diuretics [27] | 178 mL/6 h | 42 | – | – | 0.73 (0.58, 0.89) before, 0.85(0.72, 0.99) after cessation |
Raurich et al., diuretics [27] | 178 mL/6 h | 59 | – | – | 0.86 (0.76, 0.88) before, 0.94 (0.88, 1.0) after cessation |
Uchino et al., no diuretics [21] | 436 mL/day | 335 | 46.5 | 80.9 | 0.845 (0.799, 0.883) |
Uchino et al., diuretics [21] | 2330 mL/day | 194 | – | – | 0.671 (0.585, 0.750) |
Yoshida et al., no diuretics [17] | 1810 mL/day | 22 | 61.5 | 77.8 | 0.71 (0.46, 0.88) |
Yoshida et al., diuretics [17] | 1720 mL/day | 30 | 72.0 | 100.0 | 0.84 (0.64, 0.94) |
Test/parameter | Value/cut-off | Timing | #Patients | Modality | Sn | Sp | OR | AUROC | Publication |
---|---|---|---|---|---|---|---|---|---|
Multivariate | |||||||||
NT-proBNP, APACHE2, UO, Cr | At initiation | 160 | CRRT | 0.70 | Han et al. [18] | ||||
Age, gender, UO, Cr | First 24 h of admission | 719 | CRRT | 0.73 | Itenov et al. [38] | ||||
RRT duration, SOFA, oliguria, age | Discontinuation | 64 | CVVH/IHD | 0.88 | Wu et al. [45] | ||||
Urine output, SOFA, #CRRT cycles | 8 h post-stop | 222 | CRRT | 0.74 | 0.74 | 0.80 | Heise et al. [42] | ||
Urine output D0, kinetic eGFR D1 | Discontinuation | 38 | CRRT | 0.84 | 1.00 | 0.93 | Yoshida et al. [17] |