{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:03:38Z","timestamp":1785413018776,"version":"3.56.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal timing of liberation from continuous renal replacement therapy (CRRT) in adults with acute kidney injury (AKI) remains uncertain. This study developed and temporally validated a model for predicting successful 7-day liberation after a planned CRRT discontinuation attempt and compared its performance with urine output and serum creatinine (SCr)-based indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective cohort included 447 adults with AKI who underwent a first planned CRRT discontinuation attempt between 2019 and 2024. Successful liberation was defined as survival without kidney replacement therapy (KRT) for 7 consecutive days after CRRT discontinuation. Patients treated in 2019\u20132022 formed the development cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f304), and those treated in 2023\u20132024 formed the temporal validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f143). Six prespecified predictors\u2014Sequential Organ Failure Assessment (SOFA) score, sepsis-associated AKI, preceding 24-h urine output, relative SCr decline over the preceding 24\u202fh, time-weighted mean arterial pressure (MAP), and vasoactive drug use\u2014were entered into a multivariable logistic regression model. Multiple imputation, bootstrap optimism correction, calibration assessment, Brier score, decision curve analysis, and sensitivity analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 241 patients (53.91%) achieved successful 7-day liberation. The optimism-corrected area under the receiver operating characteristic curve (AUC) in the development cohort was 0.860 (95% confidence interval [CI], 0.817\u20130.900), and the temporal validation AUC was 0.853 (95% CI, 0.785\u20130.913). In temporal validation, the Brier score was 0.156 (95% CI, 0.123\u20130.192), calibration intercept was \u22120.225 (95% CI, \u22120.648 to 0.198), and calibration slope was 0.984 (95% CI, 0.654\u20131.313). At the fixed development-derived threshold of 0.529, sensitivity was 84.21% and specificity was 71.64%. The full model outperformed urine output alone and SCr decline alone, whereas its AUC did not differ significantly from the combined urine output plus SCr model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This model provides individualized 7-day liberation risk estimates after standard CRRT discontinuation criteria and checklist completion. It is intended as an adjunctive risk-stratification tool for experienced clinicians and should not replace clinical judgment. Prospective multicenter external validation, local recalibration when needed, and clinical impact evaluation are warranted before implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1882567","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:10:25Z","timestamp":1785409825000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction model for successful liberation from continuous renal replacement therapy in patients with acute kidney injury: development and temporal validation"],"prefix":"10.3389","volume":"13","author":[{"given":"Zengyan","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoche","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingjiang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1007\/s40620-025-02234-4","article-title":"Epidemiology, trajectories and outcomes of acute kidney injury among hospitalized patients: a large retrospective multicenter cohort study","volume":"38","author":"Adiyeke","year":"2025","journal-title":"J Nephrol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"100641","DOI":"10.1016\/j.xkme.2023.100641","article-title":"Epidemiology and outcomes of AKI treated with continuous kidney replacement therapy: the multicenter CRRTnet study","volume":"5","author":"Rewa","year":"2023","journal-title":"Kidney Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"256","DOI":"10.2215\/CJN.04350422","article-title":"Continuous KRT: a contemporary 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