Risk prediction model for unplanned weaning during continuous renal replacement therapy: A cross-sectional study.

OBJECTIVE

To construct a risk prediction model and systematically analyze factors contributing to unplanned weaning during continuous renal replacement therapy (CRRT) in critically ill adult patients.

DESIGN

Cross-sectional, single center study.

SETTING

Dialysis Center of Third-level hospital in China.

PATIENTS: Eight hundred and thirteen critically ill adults receiving CRRT after exclusions during May 2023 to Dec 2024.

INTERVENTIONS: Prospective collection of variables during hospital admission and follow-up.

MAIN VARIABLES OF INTEREST: Demographics, clinical conditions, nursing parameters, vascular access, consumables, laboratory profiles, treatment prescriptions, and hemodynamic data.

RESULTS

Independent predictors of unplanned weaning included anticoagulant type (nemastat mesylate, OR = 10.20, 95%CI 3.15-33.02), scheduled treatment time > 24 h (OR = 6.66, 95%CI 3.22-13.79), agitation status (OR = 2.76, 95%CI 1.27-6.02), peak venous pressure > 114 mmHg (OR = 3.58, 95%CI 1.84-6.93), peak transmembrane pressure > 172 mmHg (OR = 2.19, 95%CI 1.11-4.33), weight > 70 kg (OR = 2.13, 95%CI 1.13-4.01). The model demonstrated AUCs of 0.874 (training) and 0.730 (validation).

CONCLUSIONS

This nomogram-based model integrates multidimensional risk factors and provides actionable insights for preventing unplanned CRRT weaning. Key clinical strategies include optimizing anticoagulation protocols and monitoring hemodynamic parameters. Further multicenter validation is warranted to improve generalizability.