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Abstract: TH-PO036

Impact of Fluid Overload on Patients Receiving Continuous Dialysis for AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Gunning, Samantha, University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
  • Koyner, Jay L., University of Chicago Division of the Biological Sciences, Chicago, Illinois, United States
Background

Fluid overload at the time of dialysis initiation for acute kidney injury (AKI) has been associated with dialysis dependence and mortality. This observation supports the view that there is a survival benefit associated with large fluid removal with dialysis (e.g. >10% of body weight); however, this has not been fully explored in the literature.

Methods

We conducted a single-center retrospective cohort study among adult patients admitted to the intensive care unit (ICU) at University of Chicago Medical Center with AKI treated with continuous veno-venous hemodialysis (CVVHD) from April 1, 2016 to March 31, 2020. We collected patient demographics, severity of illness, daily fluid balance in the 72 hours prior to and 7 days subsequent to CVVHD initiation, and ICU outcomes (duration of mechanical ventilation, length of stay, dialysis dependence, and mortality). Percent fluid overload was defined as total documented inputs minus outputs divided by weight on ICU admission.

Results

Cohort size was 1382 patients who were 42% female, 58% black, with an average age of 60 years. Average SOFA score was 8.5 at the time of ICU admission. In the 72 hours prior to CVVHD there was no association between percent fluid overload and 30-day mortality. In the 72 hour and 7 days after CVVHD start, there was a linear association between percent fluid overload and 30-day mortality with the lowest 30-day mortality among patients achieving greater than -10% fluid overload and highest among patient achieving greater than 10% fluid overload [Table].

Conclusion

Percent fluid overload at 72 hours and 7 days after starting CVVHD is associated with 30-day mortality. Those achieving the most substantial fluid removal had the highest 30 day survival.

Percent Fluid Overload at 72 hours prior to CVVHD, 72 hours after CVVHD, and 7 days after CVVHD
% Fluid Overload72H Pre (%)30-Day Mortality (%)72H Post (%)30-Day Mortality (%)7D Post (%)30-Day Mortality (%)
> -10%3 (0.27)1 (33.3)25 (1.9)4 (16.0)*138 (10.6)36 (26.1)*
-5% to -10%21 (1.9)11 (52.4)125 (9.6)40 (32.0)*180 (13.8)53 (29.4)*
0% to -5%274 (24.7)125 (45.6)380 (29.1)149 (39.2)277 (21.2)115 (41.5)
0% to 5%576 (52.0)284 (49.3)433 (33.2)233 (53.8)332 (25.4)190 (57.2)
5% to 10%159 (14.4)80 (50.3)179 (13.7)103 (57.5)#180 (13.8)112 (62.2)*
> 10%75 (6.8)40 (53.3)163 (12.5)108 (66.3)*198 (15.2)131 (66.2)*

*p<0.005 when comparing mortality rate to those with -5% to 5% fluid overload (using Chi-Square Test) #p<0.05 when comparing mortality rate to those with -5% to 5% fluid overload (using Chi-Square Test)

Funding

  • Commercial Support