Influence of Daily Fluid Balance prior to Continuous Renal Replacement Therapy on Outcomes in Critically Ill Patients

van Bommel EFH, Leunissen KML, Weimar W. Continuous renal replacement therapy for critically ill patients: an update. J Intensive Care Med 1994; 9: 265–280. Despite continuous progress in intensive care during the last decades, the outcome of critically ill patients in whom acute renal failure (ARF) develops is still poor. This outcome may be explained partially by the frequent occurrence of ARF as part of multiple organ systems failure (MOSF). In this complex and unstable patient population, the provision of adequate renal support with either intermittent hemodialysis or peritoneal dialysis may pose major problems. Continuous renal replacement therapy (CRRT) is now increasingly accepted as the preferred treatment modality in the management of ARF in these patients. The technique offers adequate control of biochemistry and fluid balance in hemodynamically unstable patients, thereby enabling aggressive nutritional and inotropic support without the risk of exacerbating azotemia or fluid overload. In addition, experimental and clinical data suggest that CRRT may have a beneficial influence on hemodynamics and gas exchange in patients with septic shock and (nonrenal) MOSF, independent of an impact on fluid balance. We review both technical and clinical aspects of various continuous therapies, including their impact on serum drug levels and nutrient balance. In addition, an attempt is made to clarify the possible beneficial role of CRRT in reducing patient morbidity and mortality in the ICU.

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MO837IMPACT OF DOWNTIME ON CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS WITH ACUTE KIDNEY INJURY RECEIVING CONTINUOUS RENAL REPLACEMENT THERAPY: A RETROSPECTIVE STUDY USING PROPENSITY SCORE-MATCHED ANALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0029 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jungho Shin ◽

Hyun Chul Song ◽

Jin Ho Hwang ◽

Su Hyun Kim

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Propensity Score ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Fluid Balance ◽

Critically Ill Patients ◽

Quality Indicator ◽

Kidney Injury

Abstract Background and Aims Continuous renal replacement therapy (CRRT) is essential in treating critically ill patients with acute kidney injury, and circuit downtime is considered a quality indicator. However, it remains uncertain whether CRRT downtime affects outcomes such as mortality and renal recovery. This study investigated the impact of downtime on various clinical outcomes in critically ill patients undergoing CRRT. Method A total of 216 patients who underwent CRRT were retrospectively recruited. Downtime was calculated over 4 days from CRRT initiation, and patients were classified as downtime <20% or ≥20% of potential operative time. Patients with ≥20% downtime were matched to those with <20% downtime using 1:2 propensity score matching, adjusting for age, sex, comorbidity index, and severity score. Results There were 88 patients with <20% downtime and 44 patients with ≥20% downtime. The cumulative volume and median flow rate of effluent in patients with ≥20% downtime were lower than those in patients with <20% downtime (P<0.001 and 0.062, respectively). Daily fluid balance differed on days 2 and 3 (P=0.046 and 0.031, respectively), and the difference in levels of urea and creatinine widened over time (P=0.004 and <0.001, day 4). The levels of total carbon dioxide were lower in those with ≥20% downtime (P=0.038 and 0.020 at days 2 and 3). Based on our results, ≥20% downtime was not associated with increased 28-day mortality (P=0.944). On the other hand, a subgroup analysis showed the interaction between downtime and daily fluid balance on mortality (P=0.004). In this study, downtime was not related to renal recovery. Conclusion Increased downtime could impair fluid and uremic control and acidosis management in patients undergoing CRRT. Moreover, the adverse effect of downtime on fluid control may increase mortality rate. Further studies are needed to verify the value of downtime as a quality indicator and its impact on outcomes in critically ill patients requiring CRRT.

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