Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/19563
Title: Net ultrafiltration intensity and mortality in critically ill patients with fluid overload.
Authors: Murugan, Raghavan;Balakumar, Vikram;Kerti, Samantha J;Priyanka, Priyanka;Chang, Chung-Chou H;Clermont, Gilles;Bellomo, Rinaldo;Palevsky, Paul M;Kellum, John A
Affiliation: Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Critical Care Medicine, The Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Critical Care Medicine, and Clinical & Translational Science, University of Pittsburgh, Suite 220, Room 206, 3347 Forbes Avenue, Pittsburgh, PA, 15261, USA
The University of Melbourne, Melbourne, Victoria, Australia
Issue Date: 24-Sep-2018
EDate: 2018-09-24
Citation: Critical care (London, England) 2018; 22(1): 223
Abstract: Although net ultrafiltration (UFNET) is frequently used for treatment of fluid overload in critically ill patients with acute kidney injury, the optimal intensity of UFNET is unclear. Among critically ill patients with fluid overload receiving renal replacement therapy (RRT), we examined the association between UFNET intensity and risk-adjusted 1-year mortality. We selected patients with fluid overload ≥ 5% of body weight prior to initiation of RRT from a large academic medical center ICU dataset. UFNET intensity was calculated as the net volume of fluid ultrafiltered per day from initiation of either continuous or intermittent RRT until the end of ICU stay adjusted for patient hospital admission body weight. We stratified UFNET as low (≤ 20 ml/kg/day), moderate (> 20 to ≤ 25 ml/kg/day) or high (> 25 ml/kg/day) intensity. We adjusted for age, sex, body mass index, race, surgery, baseline estimated glomerular filtration rate, oliguria, first RRT modality, pre-RRT fluid balance, duration of RRT, time to RRT initiation from ICU admission, APACHE III score, mechanical ventilation use, suspected sepsis, mean arterial pressure on day 1 of RRT, cumulative fluid balance during RRT and cumulative vasopressor dose during RRT. We fitted logistic regression for 1-year mortality, Gray's survival model and propensity matching to account for indication bias. Of 1075 patients, the distribution of high, moderate and low-intensity UFNET groups was 40.4%, 15.2% and 44.2% and 1-year mortality was 59.4% vs 60.2% vs 69.7%, respectively (p = 0.003). Using logistic regression, high-intensity compared with low-intensity UFNET was associated with lower mortality (adjusted odds ratio 0.61, 95% CI 0.41-0.93, p = 0.02). Using Gray's model, high UFNET was associated with decreased mortality up to 39 days after ICU admission (adjusted hazard ratio range 0.50-0.73). After combining low and moderate-intensity UFNET groups (n = 258) and propensity matching with the high-intensity group (n = 258), UFNET intensity > 25 ml/kg/day compared with ≤ 25 ml/kg/day was associated with lower mortality (57% vs 67.8%, p = 0.01). Findings were robust to several sensitivity analyses. Among critically ill patients with ≥ 5% fluid overload and receiving RRT, UFNET intensity > 25 ml/kg/day compared with ≤ 20 ml/kg/day was associated with lower 1-year risk-adjusted mortality. Whether tolerating intensive UFNET is just a marker for recovery or a mediator requires further research.
URI: http://ahro.austin.org.au/austinjspui/handle/1/19563
DOI: 10.1186/s13054-018-2163-1
ORCID: 0000-0002-1650-8939
0000-0002-6823-6365
PubMed URL: 30244678
Type: Journal Article
Subjects: Dialysis
Fluid overload
Intensity
Mortality
Net ultrafiltration
Renal replacement therapy
Appears in Collections:Journal articles

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