Top

Critical Care

Published in:

Open Access 01-06-2008 | Research

A positive fluid balance is associated with a worse outcome in patients with acute renal failure

Authors: Didier Payen, Anne Cornélie de Pont, Yasser Sakr, Claudia Spies, Konrad Reinhart, Jean Louis Vincent

Published in: Critical Care | Issue 3/2008

Abstract

Introduction

Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40% to 65%. The aim of the present observational study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients.

Methods

The data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. All adult patients admitted to a participating ICU between 1 and 15 May 2002, except those admitted for uncomplicated postoperative surveillance, were eligible for the study. For the purposes of this substudy, patients were divided into two groups according to whether they had ARF. The groups were compared with respect to patient characteristics, fluid balance, and outcome.

Results

Of the 3,147 patients included in the SOAP study, 1,120 (36%) had ARF at some point during their ICU stay. Sixty-day mortality rates were 36% in patients with ARF and 16% in patients without ARF (P < 0.01). Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41% versus 33% and 52% versus 32%, respectively; P < 0.01). Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score II (SAPS II), heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation. Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay.

Conclusion

In this large European multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.

Available only for authorised users

Ympa YP, Sakr Y, Reinhart K, Vincent JL: Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 2005, 118: 827-832. 10.1016/j.amjmed.2005.01.069CrossRefPubMed

Hein OV, Birnbaum J, Wernecke KD, Konertz W, Jain U, Spies C: Three-year survival after four major post-cardiac operative complications. Crit Care Med 2006, 34: 2729-2737. 10.1097/01.CCM.0000242519.71319.ADCrossRefPubMed

Jones CH, Richardson D, Goutcher E, Newstead CG, Will EJ, Cohen AT, Davison AM: Continuous venovenous high-flux dialysis in multiorgan failure: a 5-year single-center experience. Am J Kidney Dis 1998, 31: 227-233. 10.1053/ajkd.1998.v31.pm9469492CrossRefPubMed

de Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F: Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000, 26: 915-921. 10.1007/s001340051281CrossRefPubMed

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005, 294: 813-818. 10.1001/jama.294.7.813CrossRefPubMed

Schroeder TH, Hansen M, Dinkelaker K, Krueger WA, Nohe B, Fretschner R, Unertl K: Influence of underlying disease on the outcome of critically ill patients with acute renal failure. Eur J Anaesthesiol 2004, 21: 848-853. 10.1017/S026502150400016XCrossRefPubMed

Dharan KS, John GT, Antonisamy B, Kirubakaran MG, Jacob CK: Prediction of mortality in acute renal failure in the tropics. Ren Fail 2005, 27: 289-296. 10.1081/JDI-200056612CrossRefPubMed

Loza R, Estremadoyro L, Loza C, Cieza J: Factors associated with mortality in acute renal failure (ARF) in children. Pediatr Nephrol 2006, 21: 106-109. 10.1007/s00467-005-2038-yCrossRefPubMed

du Cheyron D, Parienti JJ, Fekih-Hassen M, Daubin C, Charbonneau P: Impact of anemia on outcome in critically ill patients with severe acute renal failure. Intensive Care Med 2005, 31: 1529-1536. 10.1007/s00134-005-2739-5CrossRefPubMed

10.

Wang IK, Wang ST, Chang HY, Lin CL, Kuo HL, Chen TC, Lee CH, Chuang FR: Prognostic value of acute physiology and chronic health evaluation II and organ system failure in patients with acute renal failure requiring dialysis. Ren Fail 2005, 27: 663-669. 10.1080/08860220500234881CrossRefPubMed

11.

Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, Le Gall JR, Druml W: Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 2002, 30: 2051-2058. 10.1097/00003246-200209000-00016CrossRefPubMed

12.

Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3ACrossRefPubMed

13.

Mitchell JP, Schuller D, Calandrino FS, Schuster DP: Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis 1992, 145: 990-998.CrossRefPubMed

14.

Upadya A, Tilluckdharry L, Muralidharan V, Amoateng-Adjepong Y, Manthous CA: Fluid balance and weaning outcomes. Intensive Care Med 2005, 31: 1643-1647. 10.1007/s00134-005-2801-3CrossRefPubMed

15.

Sakr Y, Vincent JL, Reinhart K, Groeneveld J, Michalopoulos A, Sprung CL, Artigas A, Ranieri VM: High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest 2005, 128: 3098-3108. 10.1378/chest.128.5.3098CrossRefPubMed

16.

Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA: Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest 2000, 117: 1749-1754. 10.1378/chest.117.6.1749CrossRefPubMed

17.

Van Biesen W, Yegenaga I, Vanholder R, Verbeke F, Hoste E, Colardyn F, Lameire N: Relationship between fluid status and its management on acute renal failure (ARF) in intensive care unit (ICU) patients with sepsis: a prospective analysis. J Nephrol 2005, 18: 54-60.PubMed

18.

Mehta RL, Clark WC, Schetz M: Techniques for assessing and achieving fluid balance in acute renal failure. Curr Opin Crit Care 2002, 8: 535-543. 10.1097/00075198-200212000-00009CrossRefPubMed

19.

Shilliday IR, Quinn KJ, Allison ME: Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study. Nephrol Dial Transplant 1997, 12: 2592-2596. 10.1093/ndt/12.12.2592CrossRefPubMed

20.

Nakanishi K, Hirasawa H, Sugai T, Oda S, Shiga H, Kitamura N, Sadahiro T, Hirano T, Abe R, Nakada T, Hirasawa G: Efficacy of continuous hemodiafiltration for patients with congestive heart failure. Blood Purif 2002, 20: 342-348. 10.1159/000063102CrossRefPubMed

21.

Garzia F, Todor R, Scalea T: Continuous arteriovenous hemofiltration countercurrent dialysis (CAVH-D) in acute respiratory failure (ARDS). J Trauma 1991, 31: 1277-1285.CrossRefPubMed

22.

DiCarlo JV, Dudley TE, Sherbotie JR, Kaplan BS, Costarino AT: Continuous arteriovenous hemofiltration/dialysis improves pulmonary gas exchange in children with multiple organ system failure. Crit Care Med 1990, 18: 822-826. 10.1097/00003246-199008000-00005CrossRefPubMed

23.

Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ: Acute renal failure in intensive care units – causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996, 24: 192-198. 10.1097/00003246-199602000-00003CrossRefPubMed

24.

Gettings LG, Reynolds HN, Scalea T: Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs. late. Intensive Care Med 1999, 25: 805-813. 10.1007/s001340050956CrossRefPubMed

25.

Elahi MM, Lim MY, Joseph RN, Dhannapuneni RR, Spyt TJ: Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure. Eur J Cardiothorac Surg 2004, 26: 1027-1031. 10.1016/j.ejcts.2004.07.039CrossRefPubMed

26.

Demirkilic U, Kuralay E, Yenicesu M, Caglar K, Oz BS, Cingoz F, Gunay C, Yildirim V, Ceylan S, Arslan M, Vural A, Tatar H: Timing of replacement therapy for acute renal failure after cardiac surgery. J Card Surg 2004, 19: 17-20. 10.1111/j.0886-0440.2004.04004.xCrossRefPubMed

27.

Piccinni P, Dan M, Barbacini S, Carraro R, Lieta E, Marafon S, Zamperetti N, Brendolan A, D'Intini V, Tetta C, Bellomo R, Ronco C: Early isovolaemic haemofiltration in oliguric patients with septic shock. Intensive Care Med 2006, 32: 80-86. 10.1007/s00134-005-2815-xCrossRefPubMed

28.

Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-van Straaten HM, Ronco C, Kellum JA: Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care, in press.

29.

Bouman CS, Oudemans-van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J: Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med 2002, 30: 2205-2211. 10.1097/00003246-200210000-00005CrossRefPubMed

Title: A positive fluid balance is associated with a worse outcome in patients with acute renal failure
Authors: Didier Payen
Anne Cornélie de Pont
Yasser Sakr
Claudia Spies
Konrad Reinhart
Jean Louis Vincent
Publication date: 01-06-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6916

ACC 2024 Congress

Springer Medicine

A positive fluid balance is associated with a worse outcome in patients with acute renal failure

Abstract

Introduction

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2008

Clinical review: Influenza pandemic – physicians and their obligations

Heparin-induced thrombocytopenia during renal replacement therapy in the intensive care unit

Pro/Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients?

Are serum cytokines early predictors for the outcome of burn patients with inhalation injuries who do not survive?

Mild therapeutic hypothermia shortens intensive care unit stay of survivors after out-of-hospital cardiac arrest compared to historical controls

Adrenal insufficiency in prolonged critical illness