Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

Zhang, Jing; Crichton, Siobhan; Dixon, Alison; Seylanova, Nina; Peng, Zhiyong; Ostermann, Marlies

doi:10.1186/s13054-019-2673-5

Cited by 47 publications

(38 citation statements)

References 26 publications

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“…A similar trend was found in a study from the United Kingdom that demonstrated a link between 48-hour FB and AKI non-recovery. 21 However, that study did not explore the data further and failed to point out to what extent positive or negative 48-hour FB would promote renal dysfunction. The present study might promote the conclusion by specifically and accurately demonstrating the relationship between 48hour FB and AKI progression because the 48-hour FB <À5% or >3% was associated with the risk of AKI progression (FB <À5% [OR 7.078; p = 0.031]; FB 3%-5% [OR = 6.598; p = 0.020]; FB >5% [OR 16.453; p < 0.001]).…”

Section: Discussionmentioning

confidence: 97%

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

Chen

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Objectives: In addition to the association between positive fluid balance (FB) and acute kidney injury (AKI) after cardiac surgery reported by former studies, this study examined the relationship between FB and progressive AKI. Design: A retrospective, observational study. Setting: University teaching, grade A tertiary hospital in Shanghai, China. Participants: Adult patients after cardiac surgery from JulyÀDecember 2016. Interventions: Perioperative data relating to postoperative fluid intake and output were collected. AKI progression was defined as a worsening of AKI stage. FB was calculated as (fluid intake [L] À fluid output [L]/body weight [kg] £ 100%). Measurements and Main Results: The study comprised 1,522 patients. The incidences of AKI and progressive AKI were 33.1% (n = 504) and 18.1% (n = 91), respectively. There was an exponential increase between 24-hour FB and AKI occurrence, and an approximate "U"-shape association between 48-hour FB and AKI progression. Multivariate logistic regression showed that 24-hour FB 5% was an independent risk factor for AKI incidence (odds ratio [OR] 3.976; p < 0.001) and 48-hour FB <À5% or 3% was associated with an increase of AKI progression (FB <À5%, OR 7.078 [p = 0.031]; FB 3%-5%, OR 6.598 [p = 0.020]; FB 5%, OR 16.453 [p < 0.001]). Conclusions: An exponential increase was found between 24-hour FB and AKI occurrence and a "U"-shape association between 48-hour FB and AKI progression. Both excessively negative and positive accumulative 48-hour FB increased the risk of AKI progression, suggesting cautious monitoring and application of fluid load in clinical practice.

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Section: Discussionmentioning

confidence: 97%

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

Chen

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…In a large French cohort, 5242 patients were included from 23 ICUs, 2458 patients were in stage 1 Critical Care Research and Practice (46.89%) [35], and in another Chinese cohort with a total of 3107 patients with AKI, 23.1% of these patients was in stage 1 [4]. A cohort from UK by Zhang et al which included 2525 patients with AKI in ICU showed around 41.2% of patients was in stage 1 [36].…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan

Oweis

Alshelleh

Momany

et al. 2020

Critical Care Research and Practice

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Background. Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods. A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results. 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion. AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality.

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“…12 Critical Care and Preoperative Medicine Research Group, Centre for Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK. 13 Science Service Center, Kuopio University Hospital, Kuopio, Finland. 14 Centre for Integrated Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australia.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…While fluid therapy is the traditional cornerstone of AKI prevention and treatment [6], patients with AKI are also especially prone to develop fluid overload [7]. Such fluid overload is associated with increased mortality [7][8][9][10][11] and progression of AKI [12,13]. Thus, a more restrictive fluid management approach among adequately resuscitated patients with AKI might improve outcomes by reducing congestion and improving kidney and other organ function.…”

Section: Introductionmentioning

confidence: 99%

Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial

et al. 2021

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Purpose: We compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation.Methods: This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization.Results: Mean (SD) cumulative fluid balance at 72 h from randomization was − 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) − 1148 mL (− 2200 to − 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference − 1.0 [− 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm. Conclusions:In critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified.

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Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

Cited by 47 publications

References 26 publications

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

The Effect of Postoperative Fluid Balance on the Occurrence and Progression of Acute Kidney Injury After Cardiac Surgery

Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan

Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial

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