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Abstract: TH-PO287

Treatment Time Loss and Its Association with Fluid Balance Gap and Hospital Mortality in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Braun, Chloe Grace, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Takeuchi, Tomonori, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Liu, Lucas Jing, University of Kentucky, Lexington, Kentucky, United States
  • Carter, Stuart M., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Roberts, Sarah A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Tolwani, Ashita J., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Even with CRRT, fluid balance goals are not always achieved. Recent studies showed that fluid balance gap (prescribed vs. achieved) is independently associated with hospital mortality. It has also been suggested that CRRT downtime can impair fluid management. Herein, we aimed to examine patient-related risk factors for treatment time loss and its association with hospital mortality and fluid balance gap.

Methods

Retrospective cohort study of critically ill adults receiving CRRT. Percent fluid balance gap (%FBgap) was calculated as the percentage difference between fluid balance goal and fluid balance achieved, divided by fluid balance goal. Percent treatment time loss (%TTL) was defined as the percentage of CRRT downtime in relation to the total CRRT time. We performed a linear regression model with %TTL as the dependent variable and age, sex, SOFA score at ICU admission and start of CRRT, Charlson comorbidity index, and %FBgap as independent variables. Adjusting for these clinical parameters, we further conducted a logistic regression model to determine the independent association of %TTL with hospital mortality. The correlation and interaction between %FBgap and %TTL were also examined.

Results

We included 591 patients with a median age of 60 years [IQR 50-68] and median SOFA score of 11 [IQR 7-14] at ICU admission and 13 [IQR 10-15] at start of CRRT. The median CRRT duration was 72.3h [IQR 30.7–141.4] (total of 61,718h). On average, treatment downtime per patient was 4.7h, accounting for 4.5% of total CRRT. There was no significant correlation between %FBgap and %TTL (r= -0.011, p=0.78). The multivariable model did not identify any patient-specific clinical parameters associated with %TTL. In the adjusted model, %TTL was not independently associated with hospital mortality (OR 1.02, 95%CI: 0.99–1.04) and there was no interaction between %FBgap and %TTL with hospital mortality (p interaction =0.92).

Conclusion

In this cohort of critically ill adult patients undergoing CRRT, treatment downtime only accounted for 4.5% of total CRRT time. %TTL was not independently associated with hospital mortality or significantly correlated with %FBgap. Other factors beyond %TTL need to be investigated to optimize fluid management with CRRT.

Funding

  • NIDDK Support