Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study

Jhee, Jong Hyun; Park, Sun-Hee; An, Jung Nam; Joo, Kwon Wook; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Han, Seung Hyeok; Yoo, Tae Hyun; Kang, Shin Wook; Lee, Jung Pyo

doi:10.23876/j.krcp.20.089

Cited by 5 publications

(4 citation statements)

References 42 publications

(57 reference statements)

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“…An association between higher cumulative fluid balance and higher risk of death [ 23 ] has been reported in older patients with AKI requiring CRRT.…”

Section: Discussionmentioning

confidence: 99%

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Nishino,

Kubota,

Kashiwagi

et al. 2024

Renal Failure

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Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional impairment remains unclear. We hypothesized that hepatic function markers would predict mortality in patients undergoing CRRT. We included 1,899 CRRT patients from a multi-centre database. In Phase 1, participants were classified according to the total bilirubin (T-Bil) levels on the day of, and 3 days after, CRRT initiation: T-Bil < 1.2, 1.2 ≤ T-Bil < 2, and T-Bil ≥ 2 mg/dL. In Phase 2, propensity score matching (PSM) was performed to examine the effect of a T-Bil cutoff of 1.2 mg/dL (supported by the Sequential Organ Failure Assessment score); creating two groups based on a T-Bil cutoff of 1.2 mg/dL 3 days after CRRT initiation. The primary endpoint was total mortality 90 days after CRRT initiation, which was 34.7% ( n = 571). In Phase 1, the T-Bil, aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT (De Ritis ratio) levels at CRRT initiation were not associated with the prognosis, while T-Bil, AST, and the De Ritis ratio 3 days after CRRT initiation were independent factors. In Phase 2, T-Bil ≥1.2 mg/dL on day 3 was a significant independent prognostic factor, even after PSM [hazard ratio: 2.41 (95% CI; 1.84-3.17), p < 0.001]. T-Bil ≥1.2 mg/dL 3 days after CRRT initiation predicted 90-day mortality. Changes in hepatic function markers in acute renal failure may enable stratification of high-risk patients.

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“…An association between higher cumulative fluid balance and higher risk of death [ 23 ] has been reported in older patients with AKI requiring CRRT.…”

Section: Discussionmentioning

confidence: 99%

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Nishino,

Kubota,

Kashiwagi

et al. 2024

Renal Failure

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“…Most previous studies on fluid overload in patients with AKI receiving or not receiving RRT have included a heterogeneous population of patients with AKI, including both SIAKI and non-SIAKI [9][10][11][12][13][14][15] , whereas only patients with SIAKI were included in the present study. To the best of our knowledge, the present study is the first to investigate the association between fluid overload and survival in patients with SIAKI receiving CRRT.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we demonstrated that both %FOpreCRRT and %FOtotal were independent risk factors for the 28-day mortality in patients with SIAKI receiving CRRT, and the results of our study are in line with those of previous studies. However, most previous studies have only assessed fluid accumulation either before RRT 10,14,15 or during the period of ICU or hospital stay 11,12 . In contrast, the present study assessed both %FOpre-CRRT, in which initial fluid resuscitation was implemented in patients with SIAKI, and %FOtotal, in which the effect of CRRT on fluid overload was reflected.…”

Section: Discussionmentioning

confidence: 99%

Effect of fluid overload on survival in patients with sepsis-induced acute kidney injury receiving continuous renal replacement therapy

Kim

et al. 2023

Sci Rep

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The association between fluid overload and survival has not been well elucidated in critically ill patients with sepsis-induced acute kidney injury (SIAKI) receiving continuous renal replacement therapy (CRRT). We investigated the optimal cutoff value of fluid overload for predicting mortality and whether minimizing fluid overload through CRRT is associated with a survival benefit in these patients. We examined 543 patients with SIAKI who received CRRT in our intensive care unit. The degree of cumulative fluid overload in relation to body weight was expressed as the percentage fluid overload (%FO). %FO was further subdivided into %FO from AKI diagnosis to CRRT initiation (%FOpreCRRT) and total fluid overload (%FOtotal). The best cutoff value of fluid overload for predicting the 28-day mortality was %FOpreCRRT > 4.6% and %FOtotal > 9.6%. Multivariable analysis demonstrated that patients with %FOpreCRRT > 4.6% and %FOtotal > 9.6% were 1.9 times and 3.37 times more likely to die than those with %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6%. The 28-day mortality was the highest in patients with %FOpreCRRT > 4.6% and %FOtotal > 9.6% (84.7%), followed by those with %FOpreCRRT ≤ 4.6% and %FOtotal > 9.6% (65.0%), %FOpreCRRT > 4.6% and %FOtotal ≤ 9.6% (43.6%), and %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6% (22%). This study demonstrated that fluid overload was independently associated with the 28-day mortality in critically ill patients with SIAKI. Future prospective studies are needed to determine whether minimizing fluid overload using CRRT improves the survival of these patients.

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“…No treatment can completely resolve the course of AKI, and conservative and supportive treatments remain the mainstay of clinical management. Supportive CRRT is an important tool to improve the prognosis of patients with severe AKI [19][20][21]; however, there are no clear guidelines for its use or concrete evidence supporting the various clinical protocols. Despite the absence of clear criteria or guidelines for selection of CRRT rather than in-termittent hemodialysis as the RRT modality, use of CRRT is recommended in cases of hemodynamic instability even when the criteria are appropriate for intermittent hemodialysis [2].…”

Section: Introductionmentioning

confidence: 99%

When and why to start continuous renal replacement therapy in critically ill patients with acute kidney injury

Kim

Song

2021

Kidney Res Clin Pract

Self Cite

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Acute kidney injury (AKI) is a common condition in critically ill patients, and may contribute to significant medical, social, and economic consequences, including death. Although there have been advances in medical technology, including continuous renal replacement therapy (CRRT), the mortality rate of AKI is high, and there is no fundamental treatment that can reverse disease progression. The decision to implement CRRT is often subjective and based primarily on the clinician’s judgment without consistent and concrete guidelines or protocols regarding when to initiate and discontinue CRRT and how to manage complications. Recently, several randomized controlled trials addressing the initiation of renal replacement therapy in critically ill patients with AKI have been completed, but clinical application of the findings is limited by the heterogeneity of the objectives and research designs. In this review, the advantages and disadvantages of CRRT initiation, clinical guideline recommendations, and the results of currently published clinical trials and meta-analyses are summarized to guide patient care and identify future research priorities.

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Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study

Cited by 5 publications

References 42 publications

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy

Effect of fluid overload on survival in patients with sepsis-induced acute kidney injury receiving continuous renal replacement therapy

When and why to start continuous renal replacement therapy in critically ill patients with acute kidney injury

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