Use of 2-hour creatinine clearance to guide cessation of continuous renal replacement therapy

Purpose: A simple test that could guide successful cessation of continuous renal replacement therapy (CRRT) in critically ill patients would be clinically useful. This study aimed to investigate whether a 2-hour creatinine clearance (2h-CrCl) measurement could more accurately predict successful cessation of CRRT than serum creatinine or urine output alone. Materials and Methods: This retrospective study identified all patients admitted to a university teaching hospital intensive care unit who received CRRT and had a 2h-CrCl measurement performed in the 12 hours preceding CRRT cessation. The ability of 2h-CrCl to predict successful discontinuation of CRRT was compared to other renal indices. Results: Of 85 patients who had 2h-CrCl performed prior to CRRT cessation 53 (62.4%)(success group) remained dialysis free 7 days after CRRT cessation. 2h-CrCl was a better predictor of remaining CRRT free at day 7 (OR, 1.108 [1.05-1.17] per 1 mL/min increase in 2 hours CrCl, P<.001) than urine output, serum creatinine or age. A 2h-CrCl value of 23 mL/min had a sensitivity, specificity and positive predictive value for remaining CRRT free at day 7 of 75.5%, 84.4%, and 88.8%, respectively. Conclusion: 2h-CrCl may be a useful measurement to help guide discontinuation from CRRT. (C) 2012 Elsevier Inc. All rights reserved.