Abstract: SA-OR012
Evaluating Fluid-Management Parameters During CRRT: Results from the CRRTnet Registry
Session Information
- AKI Trials, Therapeutics, and Risk Stratification
October 24, 2026 | Location: Room 603, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Nombera-Aznaran, Natalia R., The University of Alabama at Birmingham, Birmingham, Alabama, United States
- Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Lambert, Joshua, University of Cincinnati, Cincinnati, Ohio, United States
- Neyra, Javier A., The University of Alabama at Birmingham, Birmingham, Alabama, United States
Group or Team Name
- CRRTnet Investigators
Background
Fluid overload (FO) is associated with mortality in critically ill patients with AKI, supporting fluid removal as a central goal of CRRT. We evaluated the association between CRRT fluid-management parameters and mortality.
Methods
We performed a secondary analysis of CRRTnet, a prospective, multicenter cohort of adults receiving CRRT. We included adults aged 18-89 years with AKI. CRRT days 0–14 were analyzed at the AM/PM shift level; patients required ≥2 shifts with available same-day SOFA scores. Patients with missing key covariates or extreme outliers were excluded. Patients who died were matched to survivors by SOFA, age, sex, CRRT day, and FO%. We evaluated fluid input, urine output, prescribed and delivered CRRT dose, and net ultrafiltration rate (NUF). Associations with mortality were estimated using generalized estimating equations adjusted for SOFA, age, and sex. We also estimated reclassification to predicted survival (mortality probability <0.50) after 1-SD shifts of each parameter toward survivor-range values.
Results
1287 patients corresponding to 14,500 patient-shifts were analyzed. The cohort consisted of 41% women and had a median (IQR) age of 60 (51-69) years, Charlson score of 3 (1-4) and SOFA score at CRRT initiation of 12 (10-15). Median prescribed and delivered CRRT doses were 32.8 (27.7-40.7) and 29.8 (25.0-37.3) mL/kg/h, respectively. In-hospital mortality was 43%. NUF showed the greatest reclassification to predicted survival, particularly on CRRT days 8–14 (Figure 1). Each 1-SD increase in netUF (180 mL/h) was associated with lower odds of mortality (aOR 0.85, 95%CI 0.76–0.95, p=0.004). This association was greater in patients with FO% ≥5% (aOR 0.64, 95%CI 0.50–0.81, p<0.001), whereas no association was observed in those with FO% <5%.
Conclusion
Higher NUF was associated with lower mortality risk, particularly in patients with FO% ≥5%. NUF may represent a modifiable CRRT fluid-management target to optimize fluid removal interventions during CRRT.
Funding
- NIDDK Support – Baxter/Vantive