Current management of fluid balance in critically ill patients with acute kidney injury: A scoping review

White, Kyle; Nasser, Ahmad Bin; Gatton, Michelle L.; Laupland, Kevin B.

doi:10.1016/j.ccrj.2023.06.002

Cited by 2 publications

(2 citation statements)

References 37 publications

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“…Available knowledge on FB management in critically ill patients receiving CRRT is limited in scope and detail [11]. Most research has indirectly examined FB while focusing on the timing of CRRT initiation [2,[20][21][22][23] and NUF [12,24,25].…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

“…Despite the above observations linking fluid and FB management with mortality in critically ill adult patients on RRT, a recent scoping review found limited evidence regarding its nature, trajectory, and extent [11]. Moreover, most of the research so far has concentrated on improving fluid removal, specifically by net ultrafiltration (NUF), and studying the timing of RRT initiation.…”

Section: Introductionmentioning

confidence: 99%

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Current Fluid Management Practice in Critically Ill Adults on Continuous Renal Replacement Therapy: A Binational, Observational Study

White,

Laupland,

Ostermann

et al. 2024

Blood Purif

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Introduction In critically ill patients undergoing continuous renal replacement therapy (CRRT), a positive fluid balance (FB) is associated with adverse outcomes. However, current FB management practices in CRRT patients are poorly understood. We aimed to study FB and its components in British and Australian CRRT patients to inform future trials. Methods We obtained detailed electronic health record data on all fluid-related variables during CRRT and hourly FB for the first seven days of treatment. Results We studied 1,616 patients from three tertiary ICUs in two countries. After the start of CRRT, the mean cumulative FB became negative at 31 hours and remained negative over seven days to a mean nadir of -4.1 L (95% confidence intervals (CI) of -4.6 to -3.5). The net ultrafiltration (NUF) rate was the dominant fluid variable (-67.7 mL/h; SD 75.7); however, residual urine output (-34.7 mL/h; SD 54.5), crystalloid administration (48.1 mL/h; SD 44.6), and nutritional input (36.4 mL/h; SD 29.7) significantly contributed to FB. Patients with a positive FB after 72 hours of CRRT, were more severely ill, required high-dose vasopressors and had high lactate concentrations (5.0 mmol/L; IQR 2.3 – 10.5). A positive FB was independently associated with increased hospital mortality (OR 1.70; 95% CI; p=0.004). Conclusion In the study ICUs, most CRRT patients achieved a predominantly NUF-dependent negative FB. Patients with a positive FB at 72 hours had greater illness severity and haemodynamic instability. Achieving equipoise for conducting trials that target a negative early FB in such patients may be difficult.

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Section: Relationship To Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Current Fluid Management Practice in Critically Ill Adults on Continuous Renal Replacement Therapy: A Binational, Observational Study

White,

Laupland,

Ostermann

et al. 2024

Blood Purif

Self Cite

View full text Add to dashboard Cite

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Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs

Tang,

Wu,

Zhong

2024

Neurol Ther

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Introduction Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission. Methods Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. Results A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08–2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56–3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19–1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO ( P for non-linearity = 0.263 and 0.563, respectively). Conclusion Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-024-00612-x.

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Current management of fluid balance in critically ill patients with acute kidney injury: A scoping review

Cited by 2 publications

References 37 publications

Current Fluid Management Practice in Critically Ill Adults on Continuous Renal Replacement Therapy: A Binational, Observational Study

Current Fluid Management Practice in Critically Ill Adults on Continuous Renal Replacement Therapy: A Binational, Observational Study

Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs

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