Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury. Nephrol Dial Transplant 2012 Mar;27(3):956-61
Date
08/23/2011Pubmed ID
21856761Pubmed Central ID
PMC3471547DOI
10.1093/ndt/gfr470Scopus ID
2-s2.0-82255190279 (requires institutional sign-in at Scopus site) 169 CitationsAbstract
BACKGROUND: Patients with acute kidney injury (AKI) requiring initiation of renal replacement therapy (RRT) have poor short- and long-term outcomes, including the development of dialysis dependence. Currently, little is known about what factors may predict renal recovery in this population.
METHODS: We conducted a single-center, retrospective analysis of 170 hospitalized adult patients with AKI attributed to acute tubular necrosis who required inpatient initiation of RRT. Data collection included patient characteristics, laboratory data, details of hospital course and degree of fluid overload at RRT initiation. The primary outcome was recovery of renal function to dialysis independence.
RESULTS: Within 1 year of RRT initiation, 35.9% (61/170) of patients reached the primary end point of renal recovery. The median (interquartile range) duration of RRT was 11 (3-33) days and 83.6% (51/61) recovered prior to hospital discharge. Recovering patients had significantly less fluid overload at the time of RRT initiation compared to non-recovering patients (3.5 versus 9.3%, P = 0.004). In multivariate Cox proportional hazard regression analysis, a rise in percent fluid overload at dialysis initiation remained a significant negative predictor of renal recovery (hazard ratio 0.97, 95% confidence interval 0.95-1.00, P = 0.024).
CONCLUSIONS: In patients with AKI, a higher degree of fluid overload at RRT initiation predicts worse renal recovery at 1 year. Clinical trials are needed to determine whether interventions targeting fluid overload may improve patient and renal outcomes.
Author List
Heung M, Wolfgram DF, Kommareddi M, Hu Y, Song PX, Ojo AOAuthor
Dawn Felicity Wolfgram MD Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute Kidney InjuryAdult
Aged
Body Fluids
Female
Fluid Therapy
Humans
Male
Middle Aged
Renal Replacement Therapy
Retrospective Studies
Survival Rate
Time Factors
Water Intoxication