Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25054
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dc.contributor.authorSerpa Neto, Ary-
dc.contributor.authorNaorungroj, Thummaporn-
dc.contributor.authorMurugan, Raghavan-
dc.contributor.authorKellum, John A-
dc.contributor.authorGallagher, Martin-
dc.contributor.authorBellomo, Rinaldo-
dc.date2020-10-07-
dc.date.accessioned2020-10-15T03:16:44Z-
dc.date.available2020-10-15T03:16:44Z-
dc.date.issued2020-10-07-
dc.identifier.citationBlood Purification 2020; online first: 7 Octoberen
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/25054-
dc.description.abstractIn continuous renal replacement therapy (CRRT)-treated patients, a net ultrafiltration (NUF) rate >1.75 mL/kg/h has been associated with increased mortality. However, there may be heterogeneity of effect of NUF rate on mortality, according to patient characteristics. To investigate the presence and impact of heterogeneity of effect, we performed a secondary analysis of the "Randomized Evaluation of Normal versus Augmented Level of Renal Replacement Therapy" (RENAL) trial. Exposure was NUF rate (weight-adjusted fluid volume removed per hour) stratified into tertiles (<1.01 mL/kg/h; 1.01-1.75 mL/kg/h; or >1.75 mL/kg/h). Primary outcome was 90-day mortality. Patients were clustered according to baseline characteristics. Heterogeneity of effect was assessed according to clusters and baseline edema and related to the additional impact of baseline cardiovascular Sequential Organ Failure Assessment (SOFA) score. We excluded patients with missing values for baseline weight and/or treatment duration. We identified 2 clusters. The largest (cluster 1; n = 941) included more severely ill patients, with more sepsis, more edema, and more vasopressor therapy (all p < 0.001). Compared to the middle tertile, the probability of harm was greater with the high tertile of NUF rate in patients in cluster 1 and in patients with baseline edema (probability of harm, cluster 1: 99.9%; edema: 99.1%). Moreover, higher baseline cardiovascular SOFA score also increased mortality risk with both high and low compared to middle NUF rates in cluster 1 patients and in patients with edema. In CRRT patients, both high and low NUF rates may be harmful, especially in those with edema, sepsis, and greater illness severity. Cardiovascular SOFA scores modulate this association. Additional studies are needed to test these hypotheses, and targeted trials of NUF rates based on risk stratification appear justified. ClinicalTrials.gov identifier: NCT00221013.en
dc.language.isoeng-
dc.subjectAcute kidney injuryen
dc.subjectContinuous renal replacement therapyen
dc.subjectFluid balanceen
dc.subjectMortalityen
dc.subjectNet ultrafiltration rateen
dc.titleHeterogeneity of Effect of Net Ultrafiltration Rate among Critically Ill Adults Receiving Continuous Renal Replacement Therapy.en
dc.typeJournal Articleen
dc.identifier.journaltitleBlood Purificationen
dc.identifier.affiliationIntensive Careen
dc.identifier.affiliationCentre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australiaen
dc.identifier.affiliationDepartment of Intensive Care, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand,.en
dc.identifier.affiliationDepartment of Critical Care Medicine, University of Pittsburgh School of Medicine Pittsburgh, Pittsburgh, Pennsylvania, USAen
dc.identifier.affiliationDepartment of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modelling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAen
dc.identifier.affiliationDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazilen
dc.identifier.affiliationData Analytics Research and Evaluation (DARE) Centreen
dc.identifier.affiliationDepartment of Critical Care Medicine, The Center for Critical Care Nephrology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAen
dc.identifier.affiliationDepartment of Nephrology, The George Institute for Global Health and University of Sydney, Sidney, New South Wales, Australiaen
dc.identifier.affiliationDepartment of Intensive Care, Amsterdam University Medical Centers, Location "AMC", Amsterdam, The Netherlandsen
dc.identifier.doi10.1159/000510556en
dc.type.contentTexten
dc.identifier.pubmedid33027799-
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