Abstract
This Practice Point commentary discusses the findings from the secondary analysis of a large systematic cohort study of critically ill patients that evaluated the influence of fluid overload on outcomes from acute kidney injury (AKI). Payen et al. reported a 36% incidence of AKI among the 3,147 patients enrolled in the Sepsis Occurrence in Acutely Ill Patients (SOAP) study. Mortality rate at 60 days was more than twofold higher among patients who had AKI than among those without AKI. Among patients with AKI, mortality rates were increased in patients with oliguria and in those treated with renal replacement therapy. A positive fluid balance was an independent risk factor for 60-day mortality. The interpretation and implications of these findings for clinical practice are highlighted in this commentary. Fluid balance is probably an important factor that determines outcomes in patients with AKI who are in an intensive care unit, but additional studies are required to confirm these findings.
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References
Ricci Z et al. (2008) The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int 73: 538–546
Kellum JA et al. (2008) Fluid management in acute kidney injury. Int J Artif Organs 31: 94–95
Vincent JL et al. (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34: 344–353
Payen D et al. (2008) A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 12: R74
Mehta RL et al. (2002) Nephrology consultation in acute renal failure: does timing matter? Am J Med 113: 456–461
Rabb H et al. (2003) Acute renal failure leads to dysregulation of lung salt and water channels. Kidney Int 63: 600–606
Goldstein SL et al. (2005) Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 67: 653–658
Palevsky PM et al. (2008) Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359: 7–20
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Mehta, R. Fluid balance and acute kidney injury: the missing link for predicting adverse outcomes?. Nat Rev Nephrol 5, 10–11 (2009). https://doi.org/10.1038/ncpneph0988
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DOI: https://doi.org/10.1038/ncpneph0988
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