King's College London

Research portal

Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: A cohort study

Research output: Contribution to journalArticlepeer-review

Standard

Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy : A cohort study. / Hall, Anna; Crichton, Siobhan; Dixon, Alison; Skorniakov, Ilia; Kellum, John A.; Ostermann, Marlies.

In: CRITICAL CARE, Vol. 24, No. 1, 279, 01.06.2020.

Research output: Contribution to journalArticlepeer-review

Harvard

Hall, A, Crichton, S, Dixon, A, Skorniakov, I, Kellum, JA & Ostermann, M 2020, 'Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: A cohort study', CRITICAL CARE, vol. 24, no. 1, 279. https://doi.org/10.1186/s13054-020-02986-4

APA

Hall, A., Crichton, S., Dixon, A., Skorniakov, I., Kellum, J. A., & Ostermann, M. (2020). Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: A cohort study. CRITICAL CARE, 24(1), [279]. https://doi.org/10.1186/s13054-020-02986-4

Vancouver

Hall A, Crichton S, Dixon A, Skorniakov I, Kellum JA, Ostermann M. Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: A cohort study. CRITICAL CARE. 2020 Jun 1;24(1). 279. https://doi.org/10.1186/s13054-020-02986-4

Author

Hall, Anna ; Crichton, Siobhan ; Dixon, Alison ; Skorniakov, Ilia ; Kellum, John A. ; Ostermann, Marlies. / Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy : A cohort study. In: CRITICAL CARE. 2020 ; Vol. 24, No. 1.

Bibtex Download

@article{c9cbb2d050164aae9f0a39c5a494c567,
title = "Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy: A cohort study",
abstract = "Background: Fluid overload is associated with morbidity and mortality in patients receiving renal replacement therapy (RRT). We aimed to explore whether fluid overload at initiation of RRT was independently associated with mortality and whether changes in cumulative fluid balance during RRT were associated with outcome. Methods: We retrospectively analysed the data of patients who were admitted to the multidisciplinary adult intensive care unit (ICU) in a tertiary care centre in the UK between 2012 and 2015 and received continuous RRT (CRRT) for acute kidney injury for at least 24 h. We collected baseline demographics, body mass index (BMI), comorbidities, severity of illness, laboratory parameters at CRRT initiation, daily cumulative fluid balance (FB), daily prescribed FB target, fluid bolus and diuretic administration and outcomes. The day of the lowest cumulative FB during CRRT was identified as nadir FB. Results: Eight hundred twenty patients were analysed (median age 65 years; 49% female). At CRRT initiation, the median cumulative FB was + 1772 ml; 89 patients (10.9%) had a cumulative FB > 10% body weight (BW). Hospital survivors had a significantly lower cumulative FB at CRRT initiation compared to patients who died (1495 versus 2184 ml; p < 0.001). In the 7 days after CRRT initiation, hospital survivors had a significant decline in cumulative FB (mean decrease 473 ml per day, p < 0.001) whilst there was no significant change in cumulative FB in non-survivors (mean decrease 112 ml per day, p = 0.188). Higher severity of illness at CRRT initiation, shorter duration of CRRT, the number of days without a prescribed FB target and need for higher doses of noradrenaline were independent risk factors for not reaching a FB nadir during CRRT. Multivariable analysis showed that older age, lower BMI, higher severity of illness, need for higher doses of noradrenaline and smaller reductions in cumulative FB during CRRT were independent risk factors for ICU and hospital mortality. Cumulative FB at CRRT initiation was not independently associated with mortality. Conclusion: In adult patients receiving CRRT, a decrease in cumulative FB was independently associated with lower mortality. Fluid overload and need for vasopressor support at CRRT initiation were not independently associated with mortality after correction for severity of illness.",
keywords = "Acute kidney injury, Fluid balance, Fluid management, Fluid removal, Renal replacement therapy, Ultrafiltration",
author = "Anna Hall and Siobhan Crichton and Alison Dixon and Ilia Skorniakov and Kellum, {John A.} and Marlies Ostermann",
year = "2020",
month = jun,
day = "1",
doi = "10.1186/s13054-020-02986-4",
language = "English",
volume = "24",
journal = "CRITICAL CARE",
issn = "1364-8535",
publisher = "BIOMED CENTRAL LTD",
number = "1",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Fluid removal associates with better outcomes in critically ill patients receiving continuous renal replacement therapy

T2 - A cohort study

AU - Hall, Anna

AU - Crichton, Siobhan

AU - Dixon, Alison

AU - Skorniakov, Ilia

AU - Kellum, John A.

AU - Ostermann, Marlies

PY - 2020/6/1

Y1 - 2020/6/1

N2 - Background: Fluid overload is associated with morbidity and mortality in patients receiving renal replacement therapy (RRT). We aimed to explore whether fluid overload at initiation of RRT was independently associated with mortality and whether changes in cumulative fluid balance during RRT were associated with outcome. Methods: We retrospectively analysed the data of patients who were admitted to the multidisciplinary adult intensive care unit (ICU) in a tertiary care centre in the UK between 2012 and 2015 and received continuous RRT (CRRT) for acute kidney injury for at least 24 h. We collected baseline demographics, body mass index (BMI), comorbidities, severity of illness, laboratory parameters at CRRT initiation, daily cumulative fluid balance (FB), daily prescribed FB target, fluid bolus and diuretic administration and outcomes. The day of the lowest cumulative FB during CRRT was identified as nadir FB. Results: Eight hundred twenty patients were analysed (median age 65 years; 49% female). At CRRT initiation, the median cumulative FB was + 1772 ml; 89 patients (10.9%) had a cumulative FB > 10% body weight (BW). Hospital survivors had a significantly lower cumulative FB at CRRT initiation compared to patients who died (1495 versus 2184 ml; p < 0.001). In the 7 days after CRRT initiation, hospital survivors had a significant decline in cumulative FB (mean decrease 473 ml per day, p < 0.001) whilst there was no significant change in cumulative FB in non-survivors (mean decrease 112 ml per day, p = 0.188). Higher severity of illness at CRRT initiation, shorter duration of CRRT, the number of days without a prescribed FB target and need for higher doses of noradrenaline were independent risk factors for not reaching a FB nadir during CRRT. Multivariable analysis showed that older age, lower BMI, higher severity of illness, need for higher doses of noradrenaline and smaller reductions in cumulative FB during CRRT were independent risk factors for ICU and hospital mortality. Cumulative FB at CRRT initiation was not independently associated with mortality. Conclusion: In adult patients receiving CRRT, a decrease in cumulative FB was independently associated with lower mortality. Fluid overload and need for vasopressor support at CRRT initiation were not independently associated with mortality after correction for severity of illness.

AB - Background: Fluid overload is associated with morbidity and mortality in patients receiving renal replacement therapy (RRT). We aimed to explore whether fluid overload at initiation of RRT was independently associated with mortality and whether changes in cumulative fluid balance during RRT were associated with outcome. Methods: We retrospectively analysed the data of patients who were admitted to the multidisciplinary adult intensive care unit (ICU) in a tertiary care centre in the UK between 2012 and 2015 and received continuous RRT (CRRT) for acute kidney injury for at least 24 h. We collected baseline demographics, body mass index (BMI), comorbidities, severity of illness, laboratory parameters at CRRT initiation, daily cumulative fluid balance (FB), daily prescribed FB target, fluid bolus and diuretic administration and outcomes. The day of the lowest cumulative FB during CRRT was identified as nadir FB. Results: Eight hundred twenty patients were analysed (median age 65 years; 49% female). At CRRT initiation, the median cumulative FB was + 1772 ml; 89 patients (10.9%) had a cumulative FB > 10% body weight (BW). Hospital survivors had a significantly lower cumulative FB at CRRT initiation compared to patients who died (1495 versus 2184 ml; p < 0.001). In the 7 days after CRRT initiation, hospital survivors had a significant decline in cumulative FB (mean decrease 473 ml per day, p < 0.001) whilst there was no significant change in cumulative FB in non-survivors (mean decrease 112 ml per day, p = 0.188). Higher severity of illness at CRRT initiation, shorter duration of CRRT, the number of days without a prescribed FB target and need for higher doses of noradrenaline were independent risk factors for not reaching a FB nadir during CRRT. Multivariable analysis showed that older age, lower BMI, higher severity of illness, need for higher doses of noradrenaline and smaller reductions in cumulative FB during CRRT were independent risk factors for ICU and hospital mortality. Cumulative FB at CRRT initiation was not independently associated with mortality. Conclusion: In adult patients receiving CRRT, a decrease in cumulative FB was independently associated with lower mortality. Fluid overload and need for vasopressor support at CRRT initiation were not independently associated with mortality after correction for severity of illness.

KW - Acute kidney injury

KW - Fluid balance

KW - Fluid management

KW - Fluid removal

KW - Renal replacement therapy

KW - Ultrafiltration

UR - http://www.scopus.com/inward/record.url?scp=85085909182&partnerID=8YFLogxK

U2 - 10.1186/s13054-020-02986-4

DO - 10.1186/s13054-020-02986-4

M3 - Article

C2 - 32487189

AN - SCOPUS:85085909182

VL - 24

JO - CRITICAL CARE

JF - CRITICAL CARE

SN - 1364-8535

IS - 1

M1 - 279

ER -

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454