Factors associated with successful transition from continuous renal replacement therapy in critically ill patients: a retrospective cohort study

Background: Acute kidney injury (AKI) in critically ill patients often requires continuous renal replacement therapy (CRRT), yet predictors of successful transition off CRRT remain unclear. This study aimed to identify clinical factors associated with successful and sustained CRRT discontinuation. Methods: We retrospectively analyzed 924 adult ICU patients who received CRRT between January 2010 and December 2024. The primary outcome was successful CRRT transition, defined as discontinuation without CRRT re-initiation within 7 days or transition to intermittent hemodialysis. Multivariable logistic regression was used to evaluate associations with clinical, hemodynamic, and biochemical parameters. Results: Of 924 patients (mean age 60 ± 14 years; 66% male), 823 (89%) successfully transitioned off CRRT. Vasopressor use (adjusted odds ratio [aOR] 0.68, p = 0.0001) and mechanical ventilation (aOR 0.56, p = 0.02) were associated with lower odds of success. On transition day, higher urine output (per 1 L, aOR 1.39, p = 0.003), serum bicarbonate (aOR 1.10, p = 0.032), and mean arterial pressure (aOR 1.02, p = 0.031) were positive predictors, while elevated blood urea nitrogen (aOR 0.98, p = 0.05) and higher obligate fluid intake (per 1 L, aOR 0.84, p = 0.032) were negative predictors. At day 7, sustained success was positively associated with urine output (aOR 1.35, p = 0.008) and serum pH (aOR 1.58, p = 0.049), and negatively associated with vasopressor use (aOR 0.69, p = 0.0001) and obligate intake (aOR 0.68, p < 0.0001). Conclusion: Higher urine output, better acid-base status, and stable hemodynamics predict successful and sustained CRRT discontinuation. Ongoing vasopressor use and high fluid burden reduce the likelihood of success.