Kinetic estimated glomerular filtration rate may be a useful tool to guide hemodialysis discontinuation

ABSTRACT

Background: There are no objective criteria for the discontinuation of renal replacement therapy (RRT) in patients who have acute kidney injury (AKI). It is unknown if Kinetic Estimated Glomerular Filtration Rate (KeGFR) can be used as assessment of renal recovery in patients who underwent RRT. Methods: All critical patients in Hospital das Clínicas during September 2020 to May 2021 who started hemodialysis due to AKI and remained free of RRT for at least 2 consecutive days were included. Patients who stopped RRT due to decision for exclusive palliative care or hemodynamic instability were excluded. Patients were divided in two groups Success group (free from RRT for 7 consecutive days after their last RRT session) and failure group. Discontinuation day was defined as the second day without RRT. Variables were expressed as median (25th and 75th percentile) and categorical data as percentage. Mann Whitney test was used. Statistical significance was defined as p<0.05. Results: 72 patients were enrolled. COVID19, ischemia-reperfusion and sepsis were the main causes of AKI (37%;28,7%;24,6%, respectively), with no difference in prevalence between groups. Success group (n=47) presented higher KeFGR on the day of discontinuation (keGFR1) and in the day after (keGFR2) when compared to failure group (n=25) KeGFR1 Success 18.76ml/min vs. failure 10.21ml/min, p=0.05. KeGFR2 Success 29.38ml/min vs. failure 16.03ml/min, p<0.05. Success group had lower non renal SOFA score at discontinuation (4 vs. 6;p<0.05) and higher urine output (1600 vs. 725;p<0.05) when compared to failure group. There was no difference in diuretic use. Conclusions: KeGFR is higher in patients who succeed in stopping RRT and it may be an useful tool for decision-making. Supported by FAPESP.