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

• Published in: PloS one Vol. 12; no. 2; p. e0172137
• Main Authors: Kim, Il Young, Kim, Joo Hui, Lee, Dong Won, Lee, Soo Bong, Rhee, Harin, Seong, Eun Young, Kwak, Ihm Soo, Song, Sang Heon
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14-02-2017; Public Library of Science (PLoS)
• Subjects: Acute kidney failure; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Adult; Aged; Biology and Life Sciences; Body weight; Care and treatment; Charts; Critical Illness; Critically ill persons; Demographics; Demography; Diagnosis; Disease-Free Survival; Drug dosages; Engineering and Technology; Female; Hemodialysis; Hospitals; Humans; Intensive care; Intensive care units; Internal medicine; Kidney diseases; Kidneys; Male; Medical prognosis; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Patient outcomes; Patients; People and Places; Renal replacement therapy; Renal Replacement Therapy - adverse effects; Retrospective Studies; Review boards; Sepsis; Side effects; Survival; Survival Rate; Therapy; Urine; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172137

Fluid 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).
We 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.
Patients 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.
Our 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.