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Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy

BACKGROUND: Fluid overload, a critical consequence of acute kidney injury (AKI), is associated with worse outcomes. The optimal fluid removal rate per day during continuous renal replacement therapy (CRRT) is unknown. The purpose of this study is to evaluate the impact of the ultrafiltration rate on...

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Autores principales: Tehranian, Shahrzad, Shawwa, Khaled, Kashani, Kianoush B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886538/
https://www.ncbi.nlm.nih.gov/pubmed/33623680
http://dx.doi.org/10.1093/ckj/sfz179
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author Tehranian, Shahrzad
Shawwa, Khaled
Kashani, Kianoush B
author_facet Tehranian, Shahrzad
Shawwa, Khaled
Kashani, Kianoush B
author_sort Tehranian, Shahrzad
collection PubMed
description BACKGROUND: Fluid overload, a critical consequence of acute kidney injury (AKI), is associated with worse outcomes. The optimal fluid removal rate per day during continuous renal replacement therapy (CRRT) is unknown. The purpose of this study is to evaluate the impact of the ultrafiltration rate on mortality in critically ill patients with AKI receiving CRRT. METHODS: This was a retrospective cohort study where we reviewed 1398 patients with AKI who received CRRT between December 2006 and November 2015 at the Mayo Clinic, Rochester, MN, USA. The net ultrafiltration rate (UF(NET)) was categorized into low- and high-intensity groups (<35 and ≥35 mL/kg/day, respectively). The impact of different UF(NET) intensities on 30-day mortality was assessed using logistic regression after adjusting for age, sex, body mass index, fluid balance from intensive care unit (ICU) admission to CRRT initiation, Acute Physiologic Assessment and Chronic Health Evaluation III and sequential organ failure assessment scores, baseline serum creatinine, ICU day at CRRT initiation, Charlson comorbidity index, CRRT duration and need of mechanical ventilation. RESULTS: The mean ± SD age was 62 ± 15 years, and 827 (59%) were male. There were 696 patients (49.7%) in the low- and 702 (50.2%) in the high-intensity group. Thirty-day mortality was 755 (54%). There were 420 (60%) deaths in the low-, and 335 (48%) in the high-intensity group (P < 0.001). UF(NET) ≥35 mL/kg/day remained independently associated with lower 30-day mortality (adjusted odds ratio = 0.47, 95% confidence interval 0.37–0.59; P < 0.001) compared with <35 mL/kg/day. CONCLUSIONS: More intensive fluid removal, UF(NET) ≥35 mL/kg/day, among AKI patients receiving CRRT is associated with lower mortality. Future prospective studies are required to confirm this finding.
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spelling pubmed-78865382021-02-22 Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy Tehranian, Shahrzad Shawwa, Khaled Kashani, Kianoush B Clin Kidney J Original Articles BACKGROUND: Fluid overload, a critical consequence of acute kidney injury (AKI), is associated with worse outcomes. The optimal fluid removal rate per day during continuous renal replacement therapy (CRRT) is unknown. The purpose of this study is to evaluate the impact of the ultrafiltration rate on mortality in critically ill patients with AKI receiving CRRT. METHODS: This was a retrospective cohort study where we reviewed 1398 patients with AKI who received CRRT between December 2006 and November 2015 at the Mayo Clinic, Rochester, MN, USA. The net ultrafiltration rate (UF(NET)) was categorized into low- and high-intensity groups (<35 and ≥35 mL/kg/day, respectively). The impact of different UF(NET) intensities on 30-day mortality was assessed using logistic regression after adjusting for age, sex, body mass index, fluid balance from intensive care unit (ICU) admission to CRRT initiation, Acute Physiologic Assessment and Chronic Health Evaluation III and sequential organ failure assessment scores, baseline serum creatinine, ICU day at CRRT initiation, Charlson comorbidity index, CRRT duration and need of mechanical ventilation. RESULTS: The mean ± SD age was 62 ± 15 years, and 827 (59%) were male. There were 696 patients (49.7%) in the low- and 702 (50.2%) in the high-intensity group. Thirty-day mortality was 755 (54%). There were 420 (60%) deaths in the low-, and 335 (48%) in the high-intensity group (P < 0.001). UF(NET) ≥35 mL/kg/day remained independently associated with lower 30-day mortality (adjusted odds ratio = 0.47, 95% confidence interval 0.37–0.59; P < 0.001) compared with <35 mL/kg/day. CONCLUSIONS: More intensive fluid removal, UF(NET) ≥35 mL/kg/day, among AKI patients receiving CRRT is associated with lower mortality. Future prospective studies are required to confirm this finding. Oxford University Press 2019-12-17 /pmc/articles/PMC7886538/ /pubmed/33623680 http://dx.doi.org/10.1093/ckj/sfz179 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Tehranian, Shahrzad
Shawwa, Khaled
Kashani, Kianoush B
Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
title Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
title_full Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
title_fullStr Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
title_full_unstemmed Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
title_short Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
title_sort net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886538/
https://www.ncbi.nlm.nih.gov/pubmed/33623680
http://dx.doi.org/10.1093/ckj/sfz179
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