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Publications

Journal Article Ahead of print 5 citations

PubMed: 41843064 DOI: 10.1007/s00134-026-08357-x

Predictive factors of successful renal replacement therapy weaning : Deciding On patients Orientations after Renal replacement therapy Stopping (The DOORS study).

Intensive Care Med

Authors: Khalil Chaïbi, Yanis Akrour, Guillaume Louis, Laurent Martin Lefevre, Bertrand Pons, Sébastien Moschietto, Eric Boulet, David Hajage, Saïd Lebbah, Jean-Pierre Quenot, Frederic Sangla, Didier Dreyfuss, Stéphane Gaudry, David Legouis

Affiliations

  • Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France.
  • Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France.
  • Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France.
  • Department of Biomedical Informatics, Harvard Medical School, Boston, USA.
  • Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France. Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France.
  • Réanimation polyvalente, CHR Metz-Thionville Hôpital de Mercy, Metz, France.
  • Réanimation polyvalente, CHR départementale La Roche sur Yon, La Roche sur Yon, France.
  • Réanimation, CHU Pointe-a-Pitre/Abymes, Pointe-a-Pitre, France.
  • Réanimation polyvalente, CHG d'Avignon Henri Duffaut, Avignon, France.
  • Réanimation polyvalente, CH René Dubos, Pontoise, France.
  • Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie, Paris, France.
  • Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.
  • Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.
  • Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Common and Rare Kidney Diseases, Sorbonne Université, INSERM, UMR-S 1155, Paris, France.
  • Médecine Intensive-Réanimation, APHP, Hôpital Louis Mourier, Université Paris Cité, Colombes, France.
  • Département de réanimation médico-chirurgicale, APHP Hôpital Avicenne, Bobigny, France.
  • Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Bobigny, France.
  • Health Care Simulation Center, UFR SMBH, Université Sorbonne Paris Nord, Bobigny, France.
  • Division of Intensive Care, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.

Abstract

INTRODUCTION

Renal replacement therapy (RRT) is a life-saving intervention in severe acute kidney injury (AKI). After a clinician-initiated discontinuation, the likelihood of sustained liberation remains uncertain. We aimed to identify predictors of successful RRT weaning and to develop a pragmatic bedside tool (the UNDERSCORE) to support post-discontinuation management.

METHODS

This post-hoc analysis of two multicenter randomized trials (AKIKI and AKIKI2) included ICU patients with KDIGO stage 3 AKI managed with a conservative initiation approach. Patients were eligible if they underwent an RRT weaning attempt, defined as discontinuation for ≥ 3 consecutive days. The primary outcome was successful weaning, i.e., no RRT resumption within seven days. Independent predictors were identified using multivariable logistic regression, and the resulting model (UNDERSCORE) was externally validated in an independent Swiss ICU cohort.

RESULTS

Among 554 patients who received RRT, 180 underwent a weaning attempt and 101 (56%) were successfully weaned. Six predictors were retained to construct the UNDERSCORE: RRT duration before the attempt, septic shock on admission, baseline serum creatinine, and three clinical variables assessed after the weaning attempt (use of vasopressors, invasive mechanical ventilation, and urine output). The score showed strong discrimination in the derivation cohort (AUC 0.86, 95% CI 0.80-0.91). In the external Swiss cohort (n = 415), 338 patients (81%) were successfully weaned, with fair performance across a broader case mix (AUC 0.73, 95% CI 0.66-0.80).

CONCLUSION

The UNDERSCORE, derived from a homogeneous conservative RRT initiation cohort and validated in a diverse ICU population, provides a bedside tool to estimate the probability of sustained RRT discontinuation after an initial clinician-initiated stop.

MeSH

Therapeutics, Renal Replacement Therapy, Weaning