Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study
Abstract Background Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-04-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-024-01281-7 |
| _version_ | 1797209092044881920 |
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| author | Debora M. Hofer Livio Ruzzante Jan Waskowski Anna S. Messmer Carmen A. Pfortmueller |
| author_facet | Debora M. Hofer Livio Ruzzante Jan Waskowski Anna S. Messmer Carmen A. Pfortmueller |
| author_sort | Debora M. Hofer |
| collection | DOAJ |
| description | Abstract Background Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30). Methods Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD). Results Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; p < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period. Conclusions Fluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3. |
| first_indexed | 2024-04-24T09:49:12Z |
| format | Article |
| id | doaj.art-c9100ac794f54dbc84ca209f1200f73b |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-24T09:49:12Z |
| publishDate | 2024-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-c9100ac794f54dbc84ca209f1200f73b2024-04-14T11:29:17ZengSpringerOpenAnnals of Intensive Care2110-58202024-04-0114111010.1186/s13613-024-01281-7Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort studyDebora M. Hofer0Livio Ruzzante1Jan Waskowski2Anna S. Messmer3Carmen A. Pfortmueller4Department of Intensive Care Medicine, Inselspital, Bern University HospitalDepartment of Intensive Care Medicine, Inselspital, Bern University HospitalDepartment of Intensive Care Medicine, Inselspital, Bern University HospitalDepartment of Intensive Care Medicine, Inselspital, Bern University HospitalDepartment of Intensive Care Medicine, Inselspital, Bern University HospitalAbstract Background Fluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30). Methods Retrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD). Results Out of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; p < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period. Conclusions Fluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3.https://doi.org/10.1186/s13613-024-01281-7Fluid managementFluid overloadRenal recoveryPersistent renal failureMAKE30 |
| spellingShingle | Debora M. Hofer Livio Ruzzante Jan Waskowski Anna S. Messmer Carmen A. Pfortmueller Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study Annals of Intensive Care Fluid management Fluid overload Renal recovery Persistent renal failure MAKE30 |
| title | Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study |
| title_full | Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study |
| title_fullStr | Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study |
| title_full_unstemmed | Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study |
| title_short | Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study |
| title_sort | influence of fluid accumulation on major adverse kidney events in critically ill patients an observational cohort study |
| topic | Fluid management Fluid overload Renal recovery Persistent renal failure MAKE30 |
| url | https://doi.org/10.1186/s13613-024-01281-7 |
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