Fluid management for sepsis-induced hypotension in patients with advanced chronic kidney disease: a secondary analysis of the CLOVERS trial.

Autor: Jorda A; Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria., Douglas IS; Department of Medicine, Pulmonary Sciences and Critical Care, Anschutz Medical Campus, Denver Health and University of Colorado, Denver, CO, USA., Staudinger T; Department of Medicine I, Medical University of Vienna, Vienna, Austria., Heinz G; Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria., Bergmann F; Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria., Oberbauer R; Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria., Sengölge G; Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria., Zeitlinger M; Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria., Jilma B; Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria., Shapiro NI; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Gelbenegger G; Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. georg.gelbenegger@meduniwien.ac.at.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Jul 11; Vol. 28 (1), pp. 231. Date of Electronic Publication: 2024 Jul 11.
DOI: 10.1186/s13054-024-05019-6
Abstrakt: Background: Early fluid management in patients with advanced chronic kidney disease (CKD) and sepsis-induced hypotension is challenging with limited evidence to support treatment recommendations. We aimed to compare an early restrictive versus liberal fluid management for sepsis-induced hypotension in patients with advanced CKD.
Methods: This post-hoc analysis included patients with advanced CKD (eGFR of less than 30 mL/min/1.73 m 2 or history of end-stage renal disease on chronic dialysis) from the crystalloid liberal or vasopressor early resuscitation in sepsis (CLOVERS) trial. The primary endpoint was death from any cause before discharge home by day 90.
Results: Of 1563 participants enrolled in the CLOVERS trial, 196 participants had advanced CKD (45% on chronic dialysis), with 92 participants randomly assigned to the restrictive treatment group and 104 assigned to the liberal fluid group. Death from any cause before discharge home by day 90 occurred significantly less often in the restrictive fluid group compared with the liberal fluid group (20 [21.7%] vs. 41 [39.4%], HR 0.5, 95% CI 0.29-0.85). Participants in the restrictive fluid group had more vasopressor-free days (19.7 ± 10.4 days vs. 15.4 ± 12.6 days; mean difference 4.3 days, 95% CI, 1.0-7.5) and ventilator-free days by day 28 (21.0 ± 11.8 vs. 16.5 ± 13.6 days; mean difference 4.5 days, 95% CI, 0.9-8.1).
Conclusions: In patients with advanced CKD and sepsis-induced hypotension, an early restrictive fluid strategy, prioritizing vasopressor use, was associated with a lower risk of death from any cause before discharge home by day 90 as compared with an early liberal fluid strategy.
Trial Registration: NCT03434028 (2018-02-09), BioLINCC 14149.
(© 2024. The Author(s).)
Databáze: MEDLINE
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