Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury

Abstract

Fluid accumulation is associated with adverse outcomes in critically ill patients. Here, we sought to determine if fluid accumulation is associated with mortality and non-recovery of kidney function in critically ill adults with acute kidney injury. Fluid overload was defined as more than a 10% increase in body weight relative to baseline, measured in 618 patients enrolled in a prospective multicenter observational study. Patients with fluid overload experienced significantly higher mortality within 60 days of enrollment. Among dialyzed patients, survivors had significantly lower fluid accumulation when dialysis was initiated compared to non-survivors after adjustments for dialysis modality and severity score. The adjusted odds ratio for death associated with fluid overload at dialysis initiation was 2.07. In non-dialyzed patients, survivors had significantly less fluid accumulation at the peak of their serum creatinine. Fluid overload at the time of diagnosis of acute kidney injury was not associated with recovery of kidney function. However, patients with fluid overload when their serum creatinine reached its peak were significantly less likely to recover kidney function. Our study shows that in patients with acute kidney injury, fluid overload was independently associated with mortality. Whether the fluid overload was the result of a more severe renal failure or it contributed to its cause will require clinical trials in which the role of fluid administration to such patients is directly tested.

Comparison of Urine Output among Patients Treated with More Intensive Versus Less Intensive RRT: Results from the Acute Renal Failure Trial Network Study

“…Similar patterns of association with mortality have been reported in studies from South America (15) and Canada (14). Greater degrees of volume overload have been associated with a higher risk of adverse outcomes, including greater risk of 60-day mortality (24,25), longer duration of ventilator dependence (18,26), and slower recovery of renal function in those with AKI requiring RRT (19). Of note, although no randomized studies have been implemented to test if earlier initiation of RRT for volume control is beneficial (because volume removal by RRT may be offset by decreases in urine output), there is biologic plausibility to suggest that preservation of urine output may be a reasonable clinical management goal.…”

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

“…Observational studies have identified several risk factors for non-recovery 48,[111][112][113][114][115][116][117] (see Supplementary information S5 (table)). Novel modalities that might enhance the prediction of non-recovery, including urine and plasma biomarkers, histopathologic markers on kidney biopsy specimens and imaging tools, should be carefully studied (BOX 6).…”

Neonatal Acute Kidney Injury

“…[82][83][84][85] Recent data extend these findings to critically ill children and adults independent of renal replacement therapy. [86][87][88] The impact of fluid overload is highlighted in the practice guidelines proposed by the American College of Critical Care Medicine for pediatric and neonatal septic shock, which recommend that interventions to address fluid balance are warranted when critically ill children amass 10% volume overload. 89 Limited data are available on fluid overload in neonates.…”