International urology and nephrology
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Severe acute kidney injury (AKI-D) is common in critically ill patients and contributes substantially to short- and long-term morbidity and mortality. Acute renal replacement therapy (RRT) is an increasingly widely utilized life-sustaining support strategy for AKI-D patients, providing a bridge to renal recovery in many survivors of AKI. However, key aspects (when and how) of this therapy's appropriate cessation remain unclear. Today, wide variation in clinical practice exists regarding the indication for and the timing of RTT discontinuation, likely due to the poor current evidence base. ⋯ The decision regarding the appropriate time to wean acute RRT is complex, integrating numerous clinical variables and renal functional parameters. Cessation of RRT should largely be individualized in critically ill patients. Large randomized multicentre trials are needed to definitively answer the vitally important question of whether inappropriate discontinuation of RRT in ICU patients with AKI-D impacts patient outcomes. Future work should integrate novel kidney damage and repair biomarkers and techniques to measure real-time glomerular filtration rates.