Table 1 Readiness for RRT liberation or de-escalation

Assessment of ICU patients in anticipation of recovery of native kidney function from AKI-D

Clinical scenarios

  Evidence of stabilization of clinical status

   Resolution of the precipitating insults

   Reduction in the acuity of the underlying disease and improvement in multi-organ dysfunctions (Haemodynamic stability, mechanical ventilation)

   Natural improvement in kidney function (spontaneous increase in urine output > 400 ml/day)

   Adequate capacity to maintain metabolic, electrolyte, acid–base homoeostasis and to manage obligatory fluid requirements by conservative management of AKI

Additional considerations

   Discharge from the ICU

   Physiotherapy and mobilization of the patient

   Logistic capabilities of the institution (staffing, nurses, availability of bedside IRRT)

Additional diagnostic measures to predict successful discontinuation of RRT

  Timed creatinine clearance (> 15 ml/min)

  Spontaneously decreasing serum creatinine

  Positive furosemide challenge, and/or urine output > 2300 ml/day on diuretics

Attempt to discontinue RRT

  Liberation versus weaning

Critical appraisal of the attempt

  Morbidity and mortality due to inadequate resolution of AKI

  Morbidity and mortality of transition to IRRT

  Re-institution of RRT

Success/failure of the attempt

  Success: no further dialysis for 7 days

  Failure: re-institution of RRT within 7 days of the attempt to stop RRT