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CRRT Liberation Failure Tied to Poor Outcomes in Acute Kidney Injury

Among critically ill patients with AKI, failure to liberate from continuous renal replacement therapy is tied to poor outcomes at 90 days

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WEDNESDAY, Nov. 3, 2021 (HealthDay News) -- Reinstitution of continuous renal replacement therapy (CRRT) after liberation failure is common in critically ill patients with acute kidney injury (AKI) and is associated with poor 90-day outcomes, according to a study published in the November issue of Mayo Clinic Proceedings.

Chang Liu, M.D., from Wuhan University in China, and colleagues examined the association between CRRT liberation and clinical outcomes among patients with AKI requiring CRRT. The analysis included 1,135 adult patients admitted to intensive care units with AKI and treated with CRRT from Jan. 1, 2007, to May 4, 2018.

The researchers found that 20 percent were liberated, 39 percent were reinstituted, and 41 percent did not survive. The rate of major adverse kidney events (MAKE90) was 62 percent, mortality was 59 percent, and RRT independence was 40 percent. The liberated group had a lower MAKE90 and higher RRT independence rate on day 90 than reinstituted patients, but there were no differences seen in 90-day mortality. Successful CRRT liberation was not associated with lower MAKE90 (odds ratio, 0.71; 95 percent confidence interval, 0.48 to 1.04; P = 0.08) but was independently associated with improved kidney recovery at 90-day follow-up (hazard ratio, 1.81; 95 percent confidence interval, 1.41 to 2.32; P < 0.001) in an adjusted analysis.

"The high rate of liberation failure observed in our study may reflect variations in clinical practices," a coauthor said in a statement. "Development of consistent approaches that can guide decision making on when to remove CRRT should be a top priority of future research."

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