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Abstract: SA-PO335

Early Body Weight Change During Continuous Renal Replacement Therapy and Subsequent Mortality in Critically Ill Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Yoon, Sung Bin, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Han, Seongwon, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Sungmi, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Seo, Minsuk, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Kim, Yoon-Goo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  • Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
Background

Fluid overload in critically ill patients is associated with adverse outcome. It has been reported that negative fluid balance during continuous renal replacement therapy (CRRT) was associated with better mortality. However, measured fluid balance often does not match body weight change. We evaluated the association between early weight change during CRRT and patient outcome.

Methods

This retrospective study included 1694 adult patients undergoing CRRT for 3 or more days from 2009 to 2017. The day of CRRT initiation was expressed as D0. Because weight change in D0 can be significantly influenced by initial resuscitation rather than fluid control by CRRT, we divided patients according to weight change from D0 to D1: group 1 (< -1 kg, 407 patients), group 2 (-1 to 0 kg, 409 patients), group 3 (0 to 1 kg, 398 patients) and group 4 (> 1 kg, 480 patients). Early weight change (kg) during CRRT was defined as D3 weight – D1 weight. Primary outcome was 90-days mortality.

Results

Overall, weight increased during the first day of CRRT and decreased thereafter, and weight gain from D0 to D3 was associated with higher mortality. Early weight change during CRRT was positively associated with higher mortality in group 4 (OR 1.14, 95% CI 1.03-1.25, P < 0.01), but not in group 1, 2 and 3. In subgroup analyses of group 4, early weight change during CRRT was positively associated with higher mortality in the surgical and cardiac ICU (OR 1.25, 95% Cl 1.09-1.44, P = 0.001 and OR 1.20, 95% Cl 1.00-1.36, P = 0.007, respectively), but not in the medical ICU.

Conclusion

Early weight reduction during CRRT, especially in patients who gain weight > 1 kg on first day of CRRT, may be beneficial. However, medical ICU patients may require more careful decisions for fluid balance management.

Funding

  • Government Support – Non-U.S.