Abstract: FR-PO083
Mind the Gap: Achieving Less Than Prescribed Net Ultrafiltration with CRRT Associates with Mortality
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 902 Fluid and Electrolytes: Clinical
Authors
- Adams, Paul M., University of Kentucky, Lexington, Kentucky, United States
- Sands, Madison K., University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Ortiz-Soriano, Victor M., University of Kentucky, Lexington, Kentucky, United States
- Kothari, Bhavya, University of Kentucky, Lexington, Kentucky, United States
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
Background
Management of fluid overload (FO) via ultrafiltration (UF) is an important goal of continuous renal replacement therapy (CRRT). Clinicians carefully assess volume status, recommending individualized UF goals. Unfortunately, UF goals are not always met, which may worsen FO. As FO is associated with poor outcomes, we hypothesize that failing to achieve UF goals will also be detrimental.
Methods
Prospective cohort study of 656 ICU adult patients requiring CRRT admitted to the University of Kentucky Hospital from 08/2017 to 04/2019. We excluded anyone missing UF data or with a mean net UF goal less than 500 mL/day. We calculated the mean percentage of achieved net UF from the prescribed net UF and the net fluid balance throughout the time on CRRT (UFnet goal achieved). Using Cox regression models adjusting for relevant confounders, we evaluated the association between UFnet goal achieved and hospital mortality.
Results
Mean age (SD) was 63.6 (25.6) years, 60% were male and 91% white. 536 (81.7%) patients required CRRT for AKI with the remainder being ESKD. Median [IQR] Charlson score was 5 [2-7] and SOFA at CRRT initiation was 13 [11-16]. Median time on CRRT was 5 [3-9] days. Hospital mortality rate was 59.5%. Time from ICU admission to CRRT initiation and prescribed net UF were not different between survivors and non-survivors. However, total fluid removal rate (ml/kg/day) was higher in survivors vs non-survivors (median 27 vs 21, p<0.001) while FO% per CRRT day was lower in survivors vs non-survivors (median -0.5% vs 0.6%, p<0.001). UFnet goal achieved was higher in survivors vs non-survivors (median, IQR: 44%, -40 to 83 vs 4.3%, -115 to 54, p<0.001). In fully adjusted models, every unit decrease in UFnet goal achieved was independently associated with hospital mortality (HR, 95% CI: 1.003, 1.001-1.006, p=0.018).
Conclusion
Our study examined UFnet goal achievement, a CRRT deliverable that requires closer attention. We found that UFnet goal underachievement was independently associated with higher mortality. Our study reinforces the value of optimizing fluid management with CRRT. Future work should focus on closing this net UF prescribed vs achieved gap by developing better tools for assessing UF goals and monitoring patient response to fluid removal.