Regarding the Relationship Between 48-Hour Fluid Balance and Acute Kidney Injury

Background: Early fluid expansion could prevent postoperative organ hypoperfusion. However, excessive fluid resuscitation adversely influences multiple organ systems. This retrospective, observational study aimed to investigate the relationship between early negative fluid balance and postoperative mortality in critically ill adult patients following cardiovascular surgery. Methods: In total, 567 critically ill patients who had undergone cardiovascular surgery and whose intensive care unit length of stay (LOS) was more than 24 hours were enrolled. The baseline characteristics, daily fluid balance and cumulative fluid balance were obtained. Patients were followed until discharge or day 28. Multivariate logistic regressions adjusted by propensity score were used to analyze the relationship between early negative fluid balance and postoperative mortality. Results: Overall, postoperative mortality was 6.2% (35/567). Acute Physiology and Chronic Health Evaluation II on admission (odd ratios [OR] 1.110), acute kidney injury stage (OR 1.639) and renal replacement therapy received (OR 3.922) were the independent risk factors of postoperative mortality, whereas negative daily fluid balance at day 2 (OR 0.411) was the protective factor. Patients with a negative daily fluid balance at day 2 had lower postoperative mortality (3.4% vs. 12.2% in the positive fluid balance group), lower acute kidney injury (AKI) stage, were less likely to receive renal replacement therapy (RRT) and experienced shorter hospital LOS compared with those with a daily positive fluid balance. Conclusion: This retrospective, observational study indicates that early negative fluid balance is associated with lower postoperative mortality in critically ill patients following cardiovascular surgery. Further prospective, randomized trials are needed to prove the benefits from the restrictive fluid management strategy.

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Continuous Renal Replacement Therapy among Patients with COVID-19 and Acute Kidney Injury

Blood Purification ◽

10.1159/000518713 ◽

2021 ◽

pp. 1-8

Author(s):

Ryann Sohaney ◽

Salma Shaikhouni ◽

John Travis Ludwig ◽

Anca Tilea ◽

Markus Bitzer ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Fluid Balance ◽

Repeated Measures ◽

Kidney Injury ◽

Regional Citrate Anticoagulation ◽

Respiratory Parameters ◽

The Relationship

Background and Objectives: Acute kidney injury (AKI) is a common complication among patients with COVID-19 and acute respiratory distress syndrome. Reports suggest that COVID-19 confers a pro-thrombotic state, which presents challenges in maintaining hemofilter patency and delivering continuous renal replacement therapy (CRRT). We present our initial experience with CRRT in critically ill patients with COVID-19, emphasizing circuit patency and the association between fluid balance during CRRT and respiratory parameters. Design, Setting, Participants, and Measurements: Retrospective chart review of 32 consecutive patients with COVID-19 and AKI managed with continuous venovenous hemodiafiltration with regional citrate anticoagulation (CVVHDF-RCA) according to the University of Michigan protocol. Primary outcome was mean CRRT circuit life per patient during the first 7 days of CRRT. We used simple linear regression to assess the relationship between patient characteristics and filter life. We also explored the relationship between fluid balance on CRRT and respiratory parameters using repeated measures modeling. Results: Patients’ mean age was 54.8 years and majority were Black (75%). Comorbidities included hypertension (90.6%), obesity (70.9%) diabetes (56.2%), and chronic kidney disease (40.6%). Median CRRT circuit life was 53.5 [interquartile range 39.1–77.6] hours. There was no association between circuit life and inflammatory or pro-thrombotic laboratory values (ferritin p = 0.92, C-reactive protein p = 0.29, D-dimer p = 0.24), or with systemic anticoagulation (p = 0.37). Net daily fluid removal during the first 7 days of CRRT was not associated with daily (closest recorded values to 20:00) PaO2/FIO2 ratio (p = 0.21) or positive end-expiratory pressure requirements (p = 0.47). Conclusions: We achieved adequate CRRT circuit life in COVID-19 patients using an established CVVHDF-RCA protocol. During the first 7 days of CRRT therapy, cumulative fluid balance was not associated with improvements in respiratory parameters, even after accounting for baseline fluid balance.

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Faculty Opinions recommendation of Fluid balance, diuretic use, and mortality in acute kidney injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11695959.14861167 ◽

2012 ◽

Author(s):

Paul Elbers ◽

Wieneke Michels

Keyword(s):

Acute Kidney Injury ◽

Fluid Balance ◽

Kidney Injury

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Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Blood Purification ◽

10.1159/000512351 ◽

2021 ◽

pp. 1-10

Author(s):

Guang Fu ◽

Hai-chao Zhan ◽

Hao-li Li ◽

Jun-fu Lu ◽

Yan-hong Chen ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Piecewise Linear ◽

Kidney Injury ◽

Multiple Logistic Regression ◽

Primary Analysis ◽

Female Patients ◽

Potential Biomarker ◽

The Relationship

Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

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