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Hourly Fluid Balance in Patients Receiving Continuous Renal Replacement Therapy
Thummaporn Naorungroj1,2, Ary Serpa Neto1,3,4, Lara Zwakman-Hessels1,5
1Department of Intensive Care Medicine, Austin Hospital, Melbourne, Victoria, Australia.
Blood Purification
|December 18, 2019
Summary
Achieving a negative fluid balance early during continuous renal replacement therapy (CRRT) is possible and linked to lower intensive care unit (ICU) mortality. This fluid balance approach is influenced by patient factors and associated with reduced mortality.
Area of Science:
- Nephrology
- Critical Care Medicine
- Intensive Care
Background:
- Early fluid balance (FB) in continuous renal replacement therapy (CRRT) is not well understood.
- Understanding early FB dynamics is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate the characteristics of early hourly and cumulative FB in CRRT patients.
- To determine the association between early FB and patient outcomes, including mortality.
Main Methods:
- Retrospective study of 350 CRRT patients from 2016-2018.
- Analysis of hourly and cumulative fluid balance data within the first 48 hours of CRRT.
- Statistical analysis to identify associations between FB and mortality.
Main Results:
- Mean hourly FB became negative after 20 CRRT hours, but earlier in fluid-overloaded patients.
- Patients on vasopressors did not achieve negative early FB (p < 0.001).
- Negative hourly FB percentage and a time-weighted FB of -33 to 18.5 mL/h were independently associated with decreased ICU mortality (31% overall mortality).
Conclusions:
- An early conservative FB approach in CRRT is feasible and associated with lower mortality.
- Patient characteristics significantly modulate early FB management.
- Avoiding early positive FB is critical for improving survival in CRRT patients.
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