{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:01:52Z","timestamp":1793102512604,"version":"4.5.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"Cincinnati Children's Hospital Medical Center","id":[{"id":"https:\/\/ror.org\/01hcyya48","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,10]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Early trial of liberation from continuous renal replacement therapy was associated with improved patient-important clinical outcomes in children with preserved urine output.<\/jats:p>\n <\/jats:list-item>\n \n Hierarchical composite end point analysis demonstrated greater intensive care unit and hospital-free days among patients who underwent a liberation trial.<\/jats:p>\n <\/jats:list-item>\n \n These findings supported early assessment of readiness for liberation using urine output to guide decision making for children receiving continuous renal replacement therapy.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Data to guide assessment of readiness for liberation from continuous renal replacement therapy (CRRT) in children are limited, and hierarchical composite end points have not been applied in this setting. We evaluated whether performing a trial of CRRT liberation among patients with preserved urine output is associated with improved outcomes using a hierarchical end point approach.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a retrospective cohort study of patients aged\u226425 years from the multicenter Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease registry. Patients with urine output >0.5 ml\/kg per hour for\u226524 hours within the first 5 days after CRRT initiation were included. The primary exposure was a trial of CRRT liberation by day 5. The primary outcome was a hierarchical composite of: (\n 1<\/jats:italic>\n ) 90-day mortality, (\n 2<\/jats:italic>\n ) 90-day KRT dependence, (\n 3<\/jats:italic>\n ) intensive care unit-free days, and (\n 4<\/jats:italic>\n ) hospital-free days. Inverse probability weighting was used to balance baseline characteristics, and outcomes were compared using a win ratio analysis.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 366 eligible patients, 192 (53%) underwent a liberation trial by day 5. These patients were older, had higher reference serum creatinine levels, and exhibited lower illness severity when compared with those who did not undergo a trial of liberation. In adjusted analyses, a liberation trial was associated with an improved hierarchical outcome (win ratio, 2.14 [95% confidence interval, 1.56 to 2.94],\n P<\/jats:italic>\n < 0.001), driven primarily by greater intensive care unit- and hospital-free days.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Among CRRT recipients with preserved urine output, a trial of liberation by day 5 was associated with improved outcomes, supporting the early assessment of liberation readiness in patients with a urine output >0.5 ml\/kg per hour.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001127","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:01:22Z","timestamp":1784131282000},"page":"1681-1690","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["A Hierarchical End Point Analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE ROCK) Cohort"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3672-7960","authenticated-orcid":false,"given":"Dana Y.","family":"Fuhrman","sequence":"first","affiliation":[{"name":"Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio"},{"name":"Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7427-670X","authenticated-orcid":false,"given":"Katja M.","family":"Gist","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital of Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5123-6713","authenticated-orcid":false,"given":"Ayse Akcan","family":"Arikan","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas"},{"name":"Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-6596","authenticated-orcid":false,"given":"Sean M.","family":"Bagshaw","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0566-8005","authenticated-orcid":false,"given":"Andrew D.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9788-5316","authenticated-orcid":false,"given":"Matthieu","family":"Legrand","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSF, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D'Arcy","family":"Duquette","sequence":"additional","affiliation":[{"name":"Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8473-0307","authenticated-orcid":false,"given":"Shina","family":"Menon","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9404-7368","authenticated-orcid":false,"given":"Nicholas J.","family":"Ollberding","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1545-6470","authenticated-orcid":false,"given":"Indrani","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaccaria","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Meyer Children's Hospital, IRCCS, IRCCS, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid","family":"Alobaidi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4436-4319","authenticated-orcid":false,"given":"Emily","family":"See","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7019-809X","authenticated-orcid":false,"given":"Danielle E.","family":"Soranno","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Selewski","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4172-916X","authenticated-orcid":false,"given":"Aadil","family":"Kakajiwala","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3711-8785","authenticated-orcid":false,"given":"Stuart L.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the WE-ROCK 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