Abstract: FR-PO091
Impact of Fluid Balance After Sepsis-Associated AKI on Development of Persistent AKI
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - I
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Kittrell, Hannah, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Oh, Wonsuk, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Kohli-Seth, Roopa D., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Nadkarni, Girish N., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Sakhuja, Ankit, West Virginia University, Morgantown, West Virginia, United States
Background
Persistent AKI (pAKI), defined as AKI lasting ≥48h is seen in over half the patients with sepsis associated AKI (SA-AKI). Fluid overload is common in patients with SA-AKI and is associated with worse outcomes. It is however unclear if net fluid balance within 48h after onset of SA-AKI (NFB-48) is associated with development of SA-pAKI.
Methods
We conducted a retrospective study using MIMIC IV database. We identified adult patients (≥18y) with sepsis who developed AKI within 48 hours of ICU admission. We defined AKI using both creatinine and urine output based KDIGO criteria. We then identified association between NFB-48 (used as tertiles) with development of SA-pAKI using logistic regression adjusted for demographics, comorbidities, SOFA score, vital signs, laboratory measurements, vasopressors and mechanical ventilation use.
Results
Of 10,739 SA-AKI patients, 62.2% developed SA-pAKI. In comparison with patients whose SA-AKI resolved within 48h, those with SA-pAKI had higher max creatinine level (1.1 vs 1.7 mg/dL; p<0.001), higher SOFA score (4.3 vs 6.3; p<0.001), more use of vasopressors (28% vs 47%; p<0.001) and mechanical ventilation (38% vs 56%;p<0.001). They also had a higher NFB-48 (0.4 vs 1.7L; p<0.001). On adjusted analysis positive NFB-48 was significantly associated with increased odds of developing SA-AKI in a stepladder pattern (Table 1).
Conclusion
We have shown that positive NFB within 48 hours after onset of SA-pAKI is significantly associated with development of SA-pAKI. The study underscores the need for optimal fluid balance in patients with SA-AKI.
Impact of NFB-48 on Development of SA-pAKI
| Net Fluid Balance within 48h after S-AKI onset (NFB-48) | Adjusted OR | 95% CI |
| Less than -0.3L | 1 | |
| -0.3 to 1.9L | 1.41 | 1.26 – 1.58 |
| More than 1.9L | 2.45 | 2.14 – 2.81 |
Funding
- NIDDK Support