Discrepancies between declared and real practices of continuous renal replacement therapy for septic acute kidney injury in French intensive care units
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) is frequent in the intensive care unit (ICU). While the timing of initiation has been extensively studied, discontinuation remains poorly defined. Current guidelines provide only vague recommendations, and CRRT liberation is mainly guided by clinical judgment. Methods: We aimed to compare declared and real CRRT weaning practices among intensivists in septic AKI.We conducted one study with two complementary investigations. Phase 1 was a nationwide survey distributed to 230 French ICUs that explored physician experience, weaning criteria, fluid balance management, urine output thresholds, and urinary biomarker use. A total of 243 intensivists from 87 ICUs responded. Phase 2 was a multicentre retrospective cohort study describing real-world management across 22 ICUs of patients with septic AKI who initiated and were subsequently weaned from CRRT. Weaning was defined as the first discontinuation of CRRT with the intent to stop, regardless of later resumption. We collected clinical, hemodynamic, renal, and fluid data over the 5 days before Day 0, the weaning day. Results: In survey phase, 93% of respondents cited urine output as the main criterion for discontinuation, with a mean reported threshold of 612 ± 328 mL/day; 74% reassessed daily, and only 3% reported using a protocol. In the retrospective cohort phase (n = 116), markedly lower urine outputs were observed at weaning (median 275 mL [30-967] on D0, 122 mL [17-562] on D-1). On weaning day, 52% of patients were still on norepinephrine (median dose 0.22 μg/kg/min, bitartrate), 72% had a positive cumulative fluid balance (median +5 L), and diuretics were prescribed in 25% of patients. In unadjusted comparisons, patients with successful weaning (63%) had higher urine output at discontinuation and more frequent diuretic use, whereas vasopressor support and fluid balance substantially overlapped between groups. In multivariable analysis, only persistent anuria as the indication for CRRT initiation remained independently associated with weaning failure. Conclusions: This combined analysis highlights a discrepancy between reported weaning practices and observed bedside management at the centre level. Despite declared reliance on urine output, hemodynamic stability, and decongestion, CRRT is often discontinued under oliguria, residual vasopressor use, and persistent fluid overload. The absence of standardized protocols underscores the need for validated composite readiness criteria that integrate urine output, vasopressor dependency, fluid status, and, possibly, urinary biomarkers.
Source: Annals of Intensive Care
Authors: Loïz Stephan, Renaud Prevel, Charline Sazio, Hugo Ilciukas-Miquel, Adrien Auvet, Simon Bodot, Riad Chelha, Valentin Coirier, Xavier Fabre, Aude Garin, Jimmy Garraud, Chloé Gisbert-Mora, Guillaume Grillet, Jan Hayon, Guylaine Labro, Alexis Lambour, Théophile Lancrey-Javal, Eliott Le Basnier, Marc Mikulski, Jonathan Nicolas, Kévin Olry, Fabienne Plouvier, Thierry Seguin, Audrey Tientcheu, Marc Valette, Olivier Guisset, Didier Gruson, Alexandre Boyer, Arthur Orieux
Institutions: Centre Hospitalier Universitaire de Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Centre Hospitalier de Dax –Côte d’Argent, Centre Hospitalier De Pau, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre Hospitalier de la Côte Basque, Centre Hospitalier de Bretagne Sud, Centre Hospitalier Intercommunal de Poissy, Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Centre Hospitalier Universitaire Amiens-Picardie, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier du Mans, Centre Hospitalier Territorial de Nouvelle-Calédonie, Centre Hospitalier Universitaire de Rouen, Centre Hospitalier Agen - Nérac, Centre Hospitalier Universitaire de Toulouse, Centre Hospitalier Universitaire de Saint-Étienne, Université de Bordeaux, Biologie des maladies cardiovasculaires
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,490
OpenAlex ID: W7161292016