Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome.

Autor: Neyra JA; Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, United States of America.; Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America., Lambert J; College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States of America., Ortiz-Soriano V; Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, United States of America., Cleland D; Performance Analytics Center of Excellence, University of Kentucky, Lexington, Kentucky, United States of America., Colquitt J; Performance Analytics Center of Excellence, University of Kentucky, Lexington, Kentucky, United States of America., Adams P; Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, United States of America., Bissell BD; Department of Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky, United States of America.; Division of Pulmonary, Department of Internal Medicine, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky, United States of America., Chan L; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai New York, New York, NY, United States of America., Nadkarni GN; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai New York, New York, NY, United States of America.; Charles Bronfman Institute of Personalized Medicine Hasso Plattner Institute of Digital Health Mount Sinai Clinical Intelligence Center, New York, NY, United States of America., Tolwani A; Division of Nephrology, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America., Goldstein SL; Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, Ohio, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Aug 25; Vol. 17 (8), pp. e0272913. Date of Electronic Publication: 2022 Aug 25 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0272913
Abstrakt: Background: Fluid management during continuous renal replacement therapy (CRRT) requires accuracy in the prescription of desired patient fluid balance (FBGoal) and precision in the attainable patient fluid balance (FBAchieved). Herein, we examined the association of the gap between prescribed vs. achieved patient fluid balance during CRRT (%FBGap) with hospital mortality in critically ill patients.
Methods: Cohort study of critically ill adults with acute kidney injury (AKI) requiring CRRT and a prescription of negative fluid balance (mean patient fluid balance goal of negative ≥0.5 liters per day). Fluid management parameters included: 1) NUF (net ultrafiltration rate); 2) FBGoal; 3) FBAchieved; and 4) FBGap (% gap of fluid balance achieved vs. goal), all adjusted by patient's weight (kg) and duration of CRRT (hours).
Results: Data from 653 patients (median of 102.2 patient-hours of CRRT) were analyzed. Mean (SD) age was 56.7 (14.6) years and 61.9% were male. Hospital mortality rate was 64%. Despite FBGoal was similar in patients who died vs. survived, survivors achieved greater negative fluid balance during CRRT than non-survivors: median FBAchieved -0.25 [-0.52 to -0.05] vs. 0.06 [-0.26 to 0.62] ml/kg/h, p<0.001. Median NUF was lower in patients who died vs. survived: 1.06 [0.63-1.47] vs. 1.22 [0.82-1.69] ml/kg/h, p<0.001, and median %FBGap was higher in patients who died (112.8%, 61.5 to 165.7) vs. survived (64.2%, 30.5 to 91.8), p<0.001. In multivariable models, higher %FBGap was independently associated with increased risk of hospital mortality: aOR (95% CI) 1.01 (1.01-1.02), p<0.001. NUF was not associated with hospital mortality when adjusted by %FBGap and other clinical parameters: aOR 0.96 (0.72-1.28), p = 0.771.
Conclusions: Higher %FBGap was independently associated with an increased risk of hospital mortality in critically ill adults with AKI on CRRT in whom clinicians prescribed negative fluid balance via CRRT. %FBGap represents a novel quality indicator of CRRT delivery that could assist with operationalizing fluid management interventions during CRRT.
Competing Interests: The authors have read the journal’s policy and have the following competing interests: JAN has received consulting honoraria from Baxter Healthcare. AT has received consulting honoraria from Baxter Healthcare. SLG receives consulting honoraria from Baxter Healthcare and Fresenius Medical Care. He has received grant funding from Baxter. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje