ReviewCritical care (London, England)2025
Liberation from continuous renal replacement therapy due to renal recovery in adults and children: a literature review and Delphi consensus on clinical practice.
Review in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- An epidemiological assessment of hemodialysis, continuous kidney replacement therapy, and peritoneal dialysis in pediatric acute kidney injury patients.Renal failure · 2026Article
- The Fluid Overload Ultrafiltration Percentage (FOUP): a novel metric that contextualizes fluid removal to initial burden in pediatric CRRT.Pediatric research · 2026Article
- Beyond Net Ultrafiltration Rate: A Precision Fluid Management Paradigm Integrating Three Key Parameters for Pediatric Continuous Renal Replacement Therapy.Critical care explorations · 2026Article
- Management of Dialysis for Patients Receiving Mechanical Circulatory Support.Journal of the American Society of Nephrology : JASN · 2026Review
- Prediction model for successful liberation from continuous renal replacement therapy in patients with acute kidney injury: development and temporal validation.Frontiers in medicine · 2026Article
- Discrepancies between declared and real practices of continuous renal replacement therapy for septic acute kidney injury in French intensive care units.Annals of intensive care · 2026Article
Corrections and comments
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere 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.
methodsEMBASE, 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.
resultsOut 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.
conclusionsUOP 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.
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