Liberation from continuous renal replacement therapy due to renal recovery in adults and children: a literature review and Delphi consensus on clinical practice
Notice bibliographique
Résumé
There is no current consensus on the appropriate timing for discontinuing continuous renal replacement therapy (CRRT). We aimed to review the current clinical evidence associated with the successful liberation from CRRT in patients with acute kidney injury and present a literature review with clinical practice points using a modified Delphi process. EMBASE, CINAHL, PubMed, and CENTRAL libraries were searched for literature related to CRRT liberation in pediatric and adult AKI patients. A two-round modified Delphi process was conducted to establish clinical and research practice points for successful liberation from CRRT in adults and children. Statements with over 75% of respondents rating them at least a 3 on a 5-point Likert scale were classified as clinically relevant practice points. Statements requiring more data were labeled as future research recommendations. Out of 1,380 articles procured, 18 studies met the eligibility criteria: ten studies on adult CRRT liberation (n = 3,357 patients) and eight on pediatric CRRT liberation (n = 939 patients). Demographic, clinical, and laboratory information were abstracted from the medical records. Four pediatric and five adult studies mentioned urine output (UOP). In adults, a 2-hour creatinine clearance above 23 mL/min was found to be a strong predictor of successful CRRT liberation, with UOP thresholds of > 60 mL/hr or > 400 mL/day correlating with successful outcomes. In pediatric patients, UOP > 0.5 mL/kg/hr within 6 h before liberation appeared to be a reliable predictor. A pooled analysis was unable to be conducted due to the limited number of studies, variations in study design, significant heterogeneity of patient populations, absence of prospective and external validation, and the lack of a standardized definition for CRRT liberation. UOP without the use of diuretics prior to liberation from CRRT was the most commonly reported predictor for successful CRRT liberation. In addition to urine output, urinary creatinine excretion, creatinine clearance, and fluid balance may be considered as potential predictive parameters when liberating from CRRT. Current recommendations emphasize the need for an individualized approach to CRRT liberation. Additional prospective studies are needed to strengthen these recommendations, focusing on the determination of UOP thresholds and validating additional clinical and biochemical parameters or risk-classification models. Our study focuses on identifying predictors for continuous renal replacement therapy (CRRT) liberation in patients recovering from acute kidney injury in both adults and children. We conducted a literature review for studies regarding discontinuing CRRT in adults and children. We used a panel of experts to establish clinical practice points that could improve patient outcomes by optimizing CRRT liberation decisions. We present practice points for various potential indicators for CRRT liberation, including urine output, serum and urinary creatinine, creatinine clearance, and fluid balance. We recommend further research to support individualized CRRT liberation decisions, which remain largely based on clinical judgment.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,162 | 0,195 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,021 | 0,013 |
| Études des sciences et des technologies | 0,003 | 0,006 |
| Communication savante | 0,006 | 0,009 |
| Science ouverte | 0,002 | 0,008 |
| Intégrité de la recherche | 0,004 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».