Weaning and Discontinuation of Renal Replacement Therapy

Renal replacement therapy is a widely used life-sustaining kidney support technique for critically ill patients with acute kidney injury. Determining the optimal duration and appropriate timing for the discontinuation of renal replacement therapy remains a complex clinical decision. Some parameters, such as urine output, serum creatinine, and creatinine clearance, have been used in significant trials to assess renal recovery and guide discontinuation. However, the decision to discontinue renal replacement therapy should be individualized, considering the patient’s overall clinical condition and capability to maintain fluid status and metabolic, electrolyte, and acid-base homeostasis. Several weaning tools and strategies can be employed to facilitate the discontinuation of renal replacement therapy. These include the furosemide stress test, the stepwise reduction of net ultrafiltration, and the switch from continuous to hybrid therapies. Close monitoring of the renal function and markers during the weaning process is crucial to detect the potential signs of renal deterioration and to make timely adjustments. This chapter extensively discusses all aspects surrounding the weaning process of renal replacement therapy and provides an approach based on current evidence to discontinue renal replacement therapy safely. Further research is clearly needed in this area of critical care medicine.