Fluid overload and survival in critically ill patients with acute kidney injury receiving continuous renal replacement therapy

Abstract

BackgroundFluid overload is known to be associated with increased mortality in patients with acute kidney injury (AKI) who are critically ill. In this study, we intended to uncover whether the adverse effect of fluid overload on survival could be applied to all of the patients with AKI who received continuous renal replacement therapy (CRRT).MethodsWe analyzed 341 patients with AKI who received CRRT in our intensive care units. The presence of fluid overload was defined as a minimum 10% increase in body weight from the baseline. Demographics, comorbid diseases, clinical data, severity of illness [the sequential organ failure assessment (SOFA) score, number of vasopressors, diagnosis of sepsis, use of ventilator] upon ICU admission, fluid overload status, and time elapsed from AKI diagnosis until CRRT initiation were reviewed from the medical charts.ResultsPatients with total fluid overload from 3 days before CRRT initiation to ICU discharge had a significantly lower survival rate after ICU admission, as compared to patients with no fluid overload (P < 0.001). Among patients with sepsis (P < 0.001) or with high SOFA scores (P < 0.001), there was a significant difference in survival of the patients with and without fluid overload. In patients without sepsis or with low SOFA score, there was no significant difference in survival of patients irrespective of fluid overload.ConclusionOur study demonstrates that the adverse effect of fluid overload on survival is more evident in patients with sepsis or with more severe illness, and that it might not apply to patients without sepsis or with less severe illness.

Is the mean platelet volume a predictive marker of a high in-hospital mortality of acute cardiorenal syndrome patients receiving continuous renal replacement therapy?

“…Although CRRT plays an important role in the treatment of patients with ACRS, [ 29 ] the timing of CRRT initiation was controversial due to the difficulty in defining early and late initiation. [ 30 – 32 ] Compared with the early intervention group, the mortality rate in the late-intervention group was higher (66.7% vs 40.0%) in this study, however, the difference was not statistically significant ( P = .118). Therefore, the relationship between the timing of CRRT and prognosis of ACRS still need to be further explored.…”

Non-recovery of renal function is a strong independent risk factor associated with mortality in AKI patients

“…Fluid overload is not only associated with AKI but can also be its result and it is pointed out as a potential prognostic biomarker of AKI, considering that its occurrence precedes the increase in creatinine and the decrease in diuresis. [18][19][20][21] Besides, many patients may have an underestimated creatinine level due to hemodilution caused by fluid overload, which restricts the identification of AKI through the application of current diagnostic criteria. 18 In an attempt to minimize this bias, Macedo et al 19 and, more recently, Thongprayoon et al 20 proposed the application of formulas to calculate the creatinine level adjusted for the positive fluid balance.…”

Effect of hemodialysis on respiratory mechanics in acute kidney injury patients

“…The daily FB was recorded, daily and the cumulative FB was recorded prior to the initial dialysis, and also at 24, 48, and 72 hours after the initial dialysis treatment. To quantify the cumulative FB over 3 days, we used the following formula: sum of daily (fluid intake [liters]—total output [liters]) . The result was expressed as means of all patients per day.…”

“…To quantify the cumulative FB over 3 days, we used the following formula: sum of daily (fluid intake [liters]-total output [liters]). 18 The result was expressed as means of all patients per day.…”