Kidney Week

Abstract: FR-PO278

Fluid Overload Is Associated with Major Adverse Kidney Events in Critically Ill Patients with AKI Requiring CRRT

Session Information

• Fluid and Electrolytes: Clinical
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Fluid and Electrolytes

• 902 Fluid and Electrolytes: Clinical

Authors

• Woodward, Connor W., University of Kentucky, Lexington, Kentucky, United States

Connor W. Woodward,

• Li, Ye, University of Kentucky , Lexington, Kentucky, United States

Ye Li,

• Lambert, Joshua, University of Kentucky , Lexington, Kentucky, United States

Joshua Lambert,

• Ruiz-Conejo, Marice, Palmetto General Hospital, Pembroke Pines, Florida, United States

Marice Ruiz-Conejo,

• Kelly, Andrew, University of Kentucky , Lexington, Kentucky, United States

Andrew Kelly,

• Bissell, Brittany D., University of Kentucky, Lexington, Kentucky, United States

Brittany D. Bissell,

• Ortiz-Soriano, Victor M., University of Kentucky, Lexington, Kentucky, United States

Victor M. Ortiz-Soriano,

• Yessayan, Lenar Tatios, University of Michigan, Ann Arbor, Michigan, United States

Lenar Tatios Yessayan,

• Morris, Peter, University of Kentucky, Lexington, Kentucky, United States

Peter Morris,

• Neyra, Javier A., University of Kentucky, Lexington, Kentucky, United States

Javier A. Neyra,

Background

Fluid overload (FO) has been associated with adverse outcome. The purpose of this study was to examine the association between FO and major adverse kidney events (MAKE) in critically ill patients with AKI requiring CRRT.

Methods

This was a single-center, retrospective, cohort study of ICU patients that suffered from AKI requiring CRRT. Patients with ESRD, kidney transplant or baseline eGFR <15 were excluded. FO was defined as cumulative fluid balance (from hospital admission to CRRT initiation) expressed as a percent of admission body weight. MAKE was determined up to 90 days following hospital discharge and consisted of the composite of mortality, RRT dependence and failure to recover at least 50% of baseline eGFR if not on RRT. A secondary outcome of ventilator-free days was also examined. Multivariable logistic regression and linear regression models were conducted.

Results

A total of 481 patients were included in the study. The median (IQR) FO was 9.9% (2.8 – 20.2%). FO ≥10% (clinical cut-off reportedly associated with adverse outcome) was found in 238 (49.5%) of patients on the day of CRRT initiation. MAKE was more frequent in patients with FO ≥10% vs <10% (79.4% vs 71.6%, p=0.047). After adjustment for demographics, comorbidity, acuity of illness, time from ICU admission to CRRT initiation, and baseline eGFR, FO ≥10% was independently associated with MAKE (OR, 1.60, 95% CI, 1.02 – 2.52). Furthermore, for each one-day increment from ICU admission to CRRT initiation, there was a 3% increase in the adjusted odds of MAKE (p=0.02). FO ≥10% was also associated with less ventilator-free days in adjusted models (p<0.01).

Conclusion

FO ≥10% on the day of CRRT initiation was independently associated with major adverse kidney events and less ventilator-free days in critically ill patients that suffered from AKI requiring CRRT. FO should be a clinical parameter routinely included in the evaluation of CRRT need in critically ill patients.

Funding

• Other NIH Support