Current conditions of discontinuation of renal replacement therapy in acute kidney injury and potential biomarkers for the decision

Abstract

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) has a poor prognosis, as indicated by its mortality rate of 50%～60%. Biomarkers for early detection, prediction of prognosis and guidance of treatment have been proposed as a novel strategy for AKI. Another strategy is to administer RRT for an appropriate term, as treatment could be discontinued for most patients with AKI. Although repeated RRT administration is a poor prognostic factor, repeated administration is necessary in 30％～40％ patients after discontinuation. Therefore, a practical biomarker to indicate appropriate RRT discontinuation is useful. Decreasing levels of urinary neutrophil gelatinase-associated lipocalin (NGAL) and hepatocyte growth factor (HGF) in 7days and 14days from starting RRT have recently been reported to predict RRT discontinuation. A panel of urinary biomarkers combined with clinical parameters may be a useful tool to indicate RTT discontinuation.