Lecture Code : PG04-S3
Session Name : PG Education 4 - Acute Kidney Injury
Session Topic : PG Education 4 - Acute Kidney Injury
Date & Time, Place : June 11 (Thu) / 13:00-14:30 / Room 2 (GBR 102), 1F
Beyond Creatinine: Integrating Novel Biomarkers and Continuous Monitoring Into CKRT Weaning Protocols
Yohan Park
Konyang University Hospital, Republic of Korea
Discontinuation of continuous kidney replacement therapy (CKRT) remains challenging due to the lack of clear and standardized criteria for kidney recovery. In clinical practice, decisions are often based on variable, institution-specific approaches, leading to inconsistency in patient management.
Several protocol-based strategies have been proposed to support more structured decision-making. These approaches focus on dynamic and functional assessment, rather than reliance on single laboratory values. Urine output is included in most protocols and remains a practical indicator of intrinsic kidney function, although its interpretation is influenced by timing and diuretic use. Functional assessment can be complemented by tests such as the furosemide stress test, as well as indices incorporating urinary solute excretion over a defined period. In addition, multivariable models integrating urine output with clinical parameters such as hemodynamic status and biochemical markers have been explored.
Despite these efforts, existing protocols vary in design, timing, and outcome definitions, and most lack external validation. As a result, no single strategy can be recommended as a standard approach.
In our ongoing work, we are exploring an approach that evaluates kidney function under conditions of reduced extracorporeal influence. Specifically, by selectively reducing middle-molecule clearance during CKRT, biomarkers such as cystatin C may better reflect intrinsic kidney function without fully discontinuing therapy. This approach may enable estimation of intrinsic kidney function even during ongoing CKRT, thereby potentially reducing the risk associated with premature discontinuation.
Further studies are needed to advance protocol-based approaches, with the goal of establishing standardized, evidence-based strategies for CKRT discontinuation.
Keywords: Continuous kidney replacement therapy, Discontinuation, Biomarkers, Protocol