Diagnostic performance of a 250-ml net ultrafiltration challenge to identify risk of preload-dependence in critically ill patients undergoing continuous renal replacement therapy: a randomized, cross-over trial
Authors' conclusion
A 250-ml UFNET challenge had acceptable diagnostic performance to identify preload-independent patients becoming preload-dependent during CRRT, with no detectable difference between fast and slow challenges.
Study context
- Population
- Adults on continuous renal replacement therapy (CRRT) with calibrated continuous cardiac index monitoring, preload-independent at enrolment36 UFNET challenges
- Participants
- 20 adults
- Comparison
- Fast vs slow 250-ml UFNET challenge
- Fast challengen = 19
- Slow challengen = 17
- Outcome
- AUROC of relative change in calibrated cardiac index before vs after challenge (∆CIUFC) to diagnose de novo preload-dependence (postural maneuver after challenge)
Methodological detailssingle-center, randomized, cross-over
- Single-center
- Randomized
- Cross-over
Performance
As reported in the abstract
De novo preload-dependence, ∆CIUFC (ITT)
Area under the receiver operating curve (AUROC) of ∆CIUFC (ITT)
0.74
95% CI 0.58–0.88
Further findings
Rate of preload-dependence after challenge (ITT)
- Preload-dependence after challenge
- 33% (12/36, 95% CI 19% to 51%)
- Intention-to-treat
AUROC of ∆CIUFC (mITT, N = 31)
- AUROC of ∆CIUFC
- 0.83 (0.66-0.99)
- ∆CIUFC not significantly differing between fast and slow challenges
- Modified intention-to-treat; 5 challenges preload-dependent before start excluded
Continuous cardiac index (CCI) variation during postural maneuver (PM) preceding challenge (mITT)
- AUROC
- 0.82 (0.65-0.98)
- Optimal threshold
- + 5%
- Modified intention-to-treat
Original publication
Diagnostic performance of a 250-ml net ultrafiltration challenge to identify risk of preload-dependence in critically ill patients undergoing continuous renal replacement therapy: a randomized, cross-over trial. Crit Care. Published 21 October 2025. doi:10.
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