Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: A case control study

Rajdev, Kartikeya; Leifer, Lazer; Sandhu, Gurkirat; Mann, Benjamin; Pervaiz, Sami; Habib, Saad; Siddiqui, Abdul Hasan; Joseph, Bino; Demissie, Seleshi; El‐Sayegh, Suzanne

doi:10.1016/j.jcrc.2019.10.008

Cited by 15 publications

(11 citation statements)

References 24 publications

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“…Acute respiratory failure requiring mechanical ventilation was associated with significantly increased mortality. As expected, high baseline APACHE II scores, low albumin, and elevated lactate levels were associated with increased mortality, which also reiterates findings from multiple previous studies [15][16]. In another study, the Liano score has been reported to identify a group of patients on dialysis for acute renal failure with a near 100% chance of mortality but did not show discrimination between those patients who died in hospital and those who did not [8,17]: Douma and associates showed in their report that the use of both the APACHE and Liano scores would be better at predicting hospital mortality [8].…”

Section: Discussionsupporting

confidence: 90%

Predictors of 15-Day Survival for the Intensive Care Unit Patient on Continuous Renal Replacement Therapy: A Retrospective Analysis

Siddiqui

Valecha

Modi

et al. 2020

Cureus

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In the intensive care unit (ICU), acute renal failure is mostly part of multiple organ dysfunction syndromes with mortality ranging from 28%-90%, continuous renal replacement therapy (CRRT) is the predominant mode of RRT used in ICU. The main objective of the study was to evaluate the outcomes in patients with acute kidney injury (AKI) on CRRT in the ICU. Methods A retrospective chart review was conducted for all ICU patients with acute renal failure on CRRT in a tertiary care teaching hospital. A subgroup analysis was conducted between 15 days in hospital survivors and non-survivors to look for predictors of survival for patients on CRRT. Results Two-hundred twenty-six patients underwent CRRT from January 2007 to December 2013. The overall in-hospital mortality was 84.1%. Fifty-six patients (24.77%) survived to the 15-day post-CRRT mark. Acute respiratory failure requiring mechanical ventilation was associated with significantly increased mortality; 89.2% vs. 97.6% (P=0.008), ICU length of stay was significantly longer in the survivor group than the nonsurvivor group. Median±IQR; {20±24 vs 6±7(P: <0.0001)} and so were the ventilator-associated days {16±24 vs 4±6.5 (P: <0.0001)} and duration of CRRT {4.5±5.5 vs 2±2.0(P: <0.0001)}. Patients who survived had a lower incidence of metabolic acidosis {44.6% vs 62.9% (P: 0. 016)} and uremic encephalopathy {12.5% vs 26.5%; (P: 0.031)} but a greater incidence of volume overload {28.6% vs 15.9% (P: 0.031)} as compared to the non-survivor. Acute Physiology And Chronic Health Evaluation II (APACHE II) scores were significantly higher in the non-survivor group (mean SD) 26.9±28.0 vs. 23.9±25.8 (P: 0.0136). Conclusions This observational study in patients undergoing CRRT in an ICU setting revealed that the overall mortality was 84.1%. Fluid overload as an indication of CRRT was associated with 1 2 3 4 5 6 7

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Section: Discussionsupporting

confidence: 90%

Predictors of 15-Day Survival for the Intensive Care Unit Patient on Continuous Renal Replacement Therapy: A Retrospective Analysis

Siddiqui

Valecha

Modi

et al. 2020

Cureus

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“…Prior data has suggested that ESRD patients have higher mortality from sepsis, with epidemiologic studies finding a 100-to 300fold increased yearly mortality rate of sepsis mortality for ESRD patients. 4,15 Although more recent studies have not found this difference, 8,16 These results coincide with findings from this analysis and prior studies. [9][10][11][12]17 Recent studies have evaluated fluid restrictive strategies in septic shock.…”

Section: Discussionsupporting

confidence: 91%

“…7 Subsequently, physicians often struggle with the decision to administer intravenous fluids to those with ESRD and sepsis. Although few previous studies have evaluated ESRD patients with sepsis and severe sepsis, [2][3][4][5][6][7][8][9][10][11][12] there currently are no known studies evaluating fluid administration and outcomes for ESRD patients specifically with septic shock.…”

Section: Importancementioning

confidence: 99%

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Outcomes of end‐stage renal disease patients in the PROCESS trial

et al. 2021

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Objective: Intravenous fluid administration is a main component of sepsis therapy, but physicians are cautious about giving fluids to end-stage renal disease (ESRD) patients out of concern for causing volume overload. We compared the outcomes of septic shock patients with and without ESRD and evaluated the association between early intravenous fluid administration and outcomes. Methods: We analyzed patients enrolled in the Protocolized Care for Early Septic Shock (PROCESS) trial, which studied different resuscitation strategies for early septic shock. Stratifying for ESRD, we compared patient characteristics, course of care, and outcomes between ESRD and non-ESRD. Using multivariable logistic regression, we determined the association between 6-hour total fluid volume (> = 30 mL/kg vs < 30 mL/kg) from preenrollment and outcomes. Results: There were 84 ESRD and 1257 non-ESRD patients. ESRD patients had a higher median Charlson Comorbidity score (5 vs 2, P < .001), higher median acute physiology and chronic health evaluation (APACHE) II score (26.5 vs 20.0, P < .001), and lower 6-hour intravenous fluid administration (54.7 vs 68.3 mL/kg, P < .001). Ninetyday mortality (33.3% vs 29.3%, P = .43) and intubation rate (31.0% vs 33.4%, P = .64) did not differ between groups. Fewer ESRD received > = 30 mL/kg (66.6% vs 86.7% P < .001). For ESRD, receipt of > = 30 mL/kg intravenous fluid did not alter any outcome. For non-ESRD patients, receiving ≥30 mL/kg of intravenous fluid was associated with increased 90-day mortality (adjusted odds ratio = 1.64; 95% confidence interval, 1.03-2.61). Conclusions: In the PROCESS trial, ESRD patients had similar outcomes to non-ESRD patients. Although ESRD patients received less intravenous fluid administration, most received over 30 mL/kg in the first 6 hours. In contrast to non-ESRD patients, receiving ≥30 mL/kg of intravenous fluid was not associated with worse outcomes in ESRD.

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“…There are a few retrospective studies where the authors concluded that the use of ≥30 mL/Kg fluid bolus in CHF patients was not associated with increased mortality or respiratory failure [ 14 , 15 ]. Additionally, some studies supported similar findings not only for CHF patients but also for other conditions that are generally considered high risk for fluid overload such as ESRD on hemodialysis (HD) and cirrhosis [ 16 , 17 ]. Kuttab et al .…”

Section: Discussionmentioning

confidence: 71%

Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

et al. 2021

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Background The use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data. Methods The retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation. Results The use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82–0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93–1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90–0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus. Conclusion The use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.

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Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: A case control study

Cited by 15 publications

References 24 publications

Predictors of 15-Day Survival for the Intensive Care Unit Patient on Continuous Renal Replacement Therapy: A Retrospective Analysis

Predictors of 15-Day Survival for the Intensive Care Unit Patient on Continuous Renal Replacement Therapy: A Retrospective Analysis

Outcomes of end‐stage renal disease patients in the PROCESS trial

Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

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