The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients

Area of Science:

• Critical Care Medicine
• Nephrology
• Fluid Physiology

Background:

• Previous studies suggested factors beyond renal replacement therapy (RRT) dose influence mortality in critically ill patients with acute kidney injury (AKI).
• This study investigates fluid balance and accumulation's impact on mortality across patient groups: without AKI (N-AKI), with AKI (AKI), and with AKI requiring RRT (AKI-RRT).

Purpose of the Study:

• To determine the association between daily fluid balance, fluid accumulation, and mortality in critically ill patients.
• To analyze the relationship between fluid overload and outcomes in patients with varying degrees of AKI.

Main Methods:

• Prospective enrollment of 1734 critically ill patients across 21 ICUs in nine countries.
• Collection of baseline characteristics, comorbidities, severity of illness, sepsis, daily fluid balance, AKI stage, RRT status, and survival.
• Calculation of fluid overload (FO) as a percentage of body weight, with maximum fluid overload (MFO) as the peak value.

Main Results:

• ICU mortality was significantly higher in AKI patients (22.3%) compared to N-AKI patients (5.6%).
• Maximum fluid overload (MFO) was independently associated with increased hospital mortality (OR 1.044 per 1% increase, adjusted for severity and AKI status).
• Fluid accumulation accelerated in the 3 days prior to AKI diagnosis and peaked 3 days post-diagnosis, occurring across all patient groups.

Conclusions:

• Both the severity and speed of fluid accumulation are independent predictors of ICU mortality in critically ill patients.
• Abnormalities in fluid balance precede and follow the diagnosis of AKI, emphasizing its critical role in patient outcomes.