Background: Despite advances in the approach to cure acute kidney injury (AKI), including definition, classification and treatment methods, there are no standard criteria to withdraw dialysis in the setting of improving AKI. We conducted this survey to elucidate parameters that United States (US) nephrologists used to determine when to stop dialysis with improving renal function in AKI. We hypothesized that there would be a difference in approach to weaning a patient off dialysis based on years in practice or the number of cases of AKI treated per year. Methods: This was an anonymous electronic survey of practicing nephrologists who treated AKI. Data was de-identified and analyzed using descriptive statistics. Results: The commonest criteria used to stop dialysis when renal function improved was, in decreasing order of importance, resolution in oliguria (51%), resolution of volume overload (29%), improvement in serum creatinine (26.7%) and resolution of hyperkalemia (21%). The most common reasons for re-starting dialysis within 28 days did not show a specific trend but respondents (20%) reported re-starting if estimated glomerular filtration rates (eGFR) declined. There was no significant pattern in approach to withdrawing dialysis or resuming dialysis based on the number of years in nephrology practice. However, responses of nephrologists who saw more than 20 AKI patients/year were significantly different in stopping dialysis with clinical stabilization of blood pressure (p < 0.001), improvement in respiratory parameters (p = 0.005), improvement in pre-dialysis blood urea nitrogen (BUN) levels despite the same dose of dialysis (p = 0.05) and resolution of oliguria (p = 0.025) compared to those who saw fewer cases. Conclusion: Resolution of oliguria was the commonest factor used to help deciding to stop dialysis in improving AKI. However, considerable variation was noted among US nephrologists who participated in this survey, regarding what criteria they used to withdraw dialysis in the setting of improving AKI. These results call for more studies in withdrawing dialysis in the setting of AKI that could lead to guideline formulation.

1.
Nash K, Hafeez A, Hou S: Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39:930-936.
2.
Liaño F, Junco E, Pascual J, Madero R, Verde E: The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid acute renal failure study group. Kidney Int Suppl 1998;66:S16-S24.
3.
Koyner JL, Cerdá J, Goldstein SL, Jaber BL, Liu KD, Shea JA, Faubel S; Acute Kidney Injury Advisory Group of the American Society of Nephrology: The daily burden of acute kidney injury: a survey of U.S. nephrologists on World Kidney Day. Am J Kidney Dis 2014;64:394-401.
4.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A; Acute Kidney Injury Network: Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
5.
Macedo E, Mehta RL: Timing of dialysis initiation in acute kidney injury and acute-on-chronic renal failure. Semin Dial 2013;26:675-681.
6.
Ricci Z, Picardo S, Ronco C: Results from international questionnaires. Contrib Nephrol 2007;156:297-303.
7.
Formica M, Inguaggiato P, Bainotti S, Gigliola G, Canepari G: Acute renal failure in critically ill patients: indications for and choice of extracorporeal treatment. J Nephrol 2007;20:15-20.
8.
Cruz DN, Ricci Z, Bagshaw SM, Piccinni P, Gibney N, Ronco C: Renal replacement therapy in adult critically ill patients: when to begin and when to stop. Contrib Nephrol 2010;165:263-273.
9.
Burns KE, Duffett M, Kho ME, Meade MO, Adhikari NK, Sinuff T, Cook DJ; ACCADEMY Group: A guide for the design and conduct of self-administered surveys of clinicians. CMAJ 2008;179:245-252.
10.
Bennett C, Khangura S, Brehaut JC, Graham ID, Moher D, Potter BK, Grimshaw JM: Reporting guidelines for survey research: an analysis of published guidance and reporting practices. PLoS Med 2010;8:e1001069.
11.
Li AH, Thomas SM, Farag A, Duffett M, Garg AX, Naylor KL: Quality of survey reporting in nephrology journals: a methodologic review. Clin J Am Soc Nephrol 2014;9:2089-2094.
12.
Otero A, Apalkov A, Fernández R, Armada M: A new device to automate the monitoring of critical patients' urine output. Biomed Res Int 2014;2014:587593.
13.
Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J: Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002;30:2205-2211.
14.
Tolwani AJ, Campbell RC, Stofan BS, Lai KR, Oster RA, Wille KM: Standard versus high-dose CVVHDF for ICU-related acute renal failure. J Am Soc Nephrol 2008;19:1233-1238.
15.
Van Wert R, Friedrich JO, Scales DC, Wald R, Adhikari NK; University of Toronto Acute Kidney Injury Research Group: High-dose renal replacement therapy for acute kidney injury: systematic review and meta-analysis. Crit Care Med 2010;38:1360-1369.
16.
Jun M, Heerspink HJ, Ninomiya T, et al: Intensities of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2010;5:956-963.
17.
Schetz M, Gunst J, Van den Berghe G: The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU. Intensive Care Med 2014;40:1709-1717.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.