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Abstract: PO0671

Fluid Balance on CRRT and Association with Respiratory Status in Patients with COVID-19 and AKI

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Ludwig, John Travis, University of Michigan, Ann Arbor, Michigan, United States
  • Sohaney, Ryann, University of Michigan, Ann Arbor, Michigan, United States
  • Shaikhouni, Salma, University of Michigan, Ann Arbor, Michigan, United States
  • Bitzer, Markus, University of Michigan, Ann Arbor, Michigan, United States
  • Yessayan, Lenar Tatios, University of Michigan, Ann Arbor, Michigan, United States
  • Tilea, Anca, University of Michigan, Ann Arbor, Michigan, United States
  • Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States
Background

Acute kidney injury is common among critically ill patients with COVID-19 (CoV-AKI), complicating the primary syndrome of ARDS. We report our single center experience with fluid management on CRRT in relation to respiratory parameters.

Methods

Retrospective chart review of 32 consecutive patients with CoV-AKI requiring CRRT admitted to the ICU at the University of Michigan between 3/23 and 4/26, with follow-up through 5/12/2020. All patients received post-filter continuous venovenous hemodiafiltration with regional citrate anticoagulation per institutional protocol. Daily cumulative fluid balance and respiratory parameters (P/F and PEEP) were recorded for the first 7 days of CRRT. We assess the relationship between cumulative fluid balance on CRRT and respiratory parameters (P/F and PEEP) with repeated measures modeling adjusted for fluid accumulation at CRRT start, height, weight, and age.

Results

Mean age 54.8, majority black (75%), and comorbidities included hypertension (90.6%), diabetes (56.2%), CKD (53.1%), and organ transplantation (18.8%). Median length of mechanical ventilation was 15.0 (12-25) days. Median cumulative fluid balance from admission to CRRT start was +3.3 (2.0- 5.6) liters. There was a trend toward increasingly negative fluid balance on CRRT (figure). When adjusting for age, weight, height and cumulative fluid balance at CRRT start, there was no association between cumulative fluid balance on CRRT and P/F (p=0.21) or PEEP (p=0.47). At end of data collection, 9 (28.1%) patients remained in the hospital, 10 (31.3%) survived to hospital discharge and 13 (40.6%) had died.

Conclusion

Cumulative fluid balance on CRRT did not correlate with change in P/F or PEEP, even after accounting for baseline fluid balance. Nevertheless, it is possible that more aggressive fluid removal is required to demonstrated an effect.

Mean Daily Fluid Balance

Funding

  • NIDDK Support