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Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric

Scott M Sutherland1, Michael Zappitelli, Steven R Alexander

  • 1Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA. suthersm@stanford.edu

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|January 1, 2010
PubMed

Insights

Critically ill children with higher fluid overload before continuous renal replacement therapy (CRRT) face increased mortality. This association highlights the need for further research into optimal fluid management strategies in pediatric intensive care units.

Area of Science:

  • Pediatric critical care medicine
  • Nephrology
  • Fluid management in critically ill children

Background:

  • Critically ill children with hemodynamic instability and acute kidney injury often experience fluid overload.
  • Continuous renal replacement therapy (CRRT) is a key treatment for these children.
  • The relationship between fluid overload and mortality in this population requires further investigation.

Purpose of the Study:

  • To investigate the association between the degree of fluid overload at the initiation of CRRT and mortality in critically ill children.
  • To determine if a higher percentage of fluid overload correlates with increased mortality rates.

Main Methods:

  • A prospective observational study was conducted with 297 children across 13 US centers.
  • Fluid overload was calculated as the percentage difference between fluid input and output from ICU admission to CRRT initiation.
  • The primary outcome was survival to pediatric intensive care unit discharge.

Main Results:

  • Children with >= 20% fluid overload at CRRT initiation had significantly higher mortality (65.6%) compared to those with 10%-20% (43.1%) and <10% (29.4%).
  • The association persisted after adjusting for illness severity, with a 3% increase in mortality for each 1% rise in fluid overload.
  • Patients with >= 20% fluid overload had an adjusted odds ratio for mortality of 8.5.

Conclusions:

  • Greater fluid overload prior to CRRT initiation is associated with higher mortality in critically ill children.
  • While an association is evident, causality cannot be definitively established due to the observational nature of the study.
  • Further research is needed to define optimal fluid overload thresholds for initiating CRRT in pediatric patients.
Abstract

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