TY - JOUR
T1 - Fluid Overload and Mortality in Children Receiving Continuous Renal Replacement Therapy
T2 - The Prospective Pediatric Continuous Renal Replacement Therapy Registry
AU - Sutherland, Scott M.
AU - Zappitelli, Michael
AU - Alexander, Steven R.
AU - Chua, Annabelle N.
AU - Brophy, Patrick D.
AU - Bunchman, Timothy E.
AU - Hackbarth, Richard
AU - Somers, Michael J.G.
AU - Baum, Michelle
AU - Symons, Jordan M.
AU - Flores, Francisco X.
AU - Benfield, Mark
AU - Askenazi, David
AU - Chand, Deepa
AU - Fortenberry, James D.
AU - Mahan, John D.
AU - McBryde, Kevin
AU - Blowey, Douglas
AU - Goldstein, Stuart L.
N1 - Funding Information:
Financial Disclosure: Dr Brophy has held consultancies with Gambro and Dialysis Solutions Inc and received honoraria from Gambro. Dr Fortenberry has received grant support from Dialysis Solutions Inc. Dr Bunchman has held consultancies with Dialysis Solutions Inc, Johnson & Johnson, Roche, and Novartis. Francisco Flores currently is a member of Gambro's Speakers Bureau. Dr Goldstein is a member of Gambro's Speakers Bureau and has received honoraria from Gambro; he also has held consultancies with Gambro and Dialysis Solutions. The remaining authors report no relevant financial interests.
PY - 2010/2
Y1 - 2010/2
N2 - Background: Critically ill children with hemodynamic instability and acute kidney injury often develop fluid overload. Continuous renal replacement therapy (CRRT) has emerged as a favored modality in the management of such children. This study investigated the association between fluid overload and mortality in children receiving CRRT. Study Design: Prospective observational study. Setting & Participants: 297 children from 13 centers across the United States participating in the Prospective Pediatric CRRT Registry. Predictor: Fluid overload from intensive care unit (ICU) admission to CRRT initiation, defined as a percentage equal to (fluid in [L] - fluid out [L])/(ICU admit weight [kg]) × 100%. Outcome & Measurements: The primary outcome was survival to pediatric ICU discharge. Data were collected regarding demographics, CRRT parameters, underlying disease process, and severity of illness. Results: 153 patients (51.5%) developed < 10% fluid overload, 51 patients (17.2%) developed 10%-20% fluid overload, and 93 patients (31.3%) developed ≥ 20% fluid overload. Patients who developed ≥ 20% fluid overload at CRRT initiation had significantly higher mortality (61/93; 65.6%) than those who had 10%-20% fluid overload (22/51; 43.1%) and those with < 10% fluid overload (45/153; 29.4%). The association between degree of fluid overload and mortality remained after adjusting for intergroup differences and severity of illness. The adjusted mortality OR was 1.03 (95% CI, 1.01-1.05), suggesting a 3% increase in mortality for each 1% increase in severity of fluid overload. When fluid overload was dichotomized to ≥ 20% and < 20%, patients with ≥ 20% fluid overload had an adjusted mortality OR of 8.5 (95% CI, 2.8-25.7). Limitations: This was an observational study; interventions were not standardized. The relationship between fluid overload and mortality remains an association without definitive evidence of causality. Conclusions: Critically ill children who develop greater fluid overload before initiation of CRRT experience higher mortality than those with less fluid overload. Further goal-directed research is required to accurately define optimal fluid overload thresholds for initiation of CRRT.
AB - Background: Critically ill children with hemodynamic instability and acute kidney injury often develop fluid overload. Continuous renal replacement therapy (CRRT) has emerged as a favored modality in the management of such children. This study investigated the association between fluid overload and mortality in children receiving CRRT. Study Design: Prospective observational study. Setting & Participants: 297 children from 13 centers across the United States participating in the Prospective Pediatric CRRT Registry. Predictor: Fluid overload from intensive care unit (ICU) admission to CRRT initiation, defined as a percentage equal to (fluid in [L] - fluid out [L])/(ICU admit weight [kg]) × 100%. Outcome & Measurements: The primary outcome was survival to pediatric ICU discharge. Data were collected regarding demographics, CRRT parameters, underlying disease process, and severity of illness. Results: 153 patients (51.5%) developed < 10% fluid overload, 51 patients (17.2%) developed 10%-20% fluid overload, and 93 patients (31.3%) developed ≥ 20% fluid overload. Patients who developed ≥ 20% fluid overload at CRRT initiation had significantly higher mortality (61/93; 65.6%) than those who had 10%-20% fluid overload (22/51; 43.1%) and those with < 10% fluid overload (45/153; 29.4%). The association between degree of fluid overload and mortality remained after adjusting for intergroup differences and severity of illness. The adjusted mortality OR was 1.03 (95% CI, 1.01-1.05), suggesting a 3% increase in mortality for each 1% increase in severity of fluid overload. When fluid overload was dichotomized to ≥ 20% and < 20%, patients with ≥ 20% fluid overload had an adjusted mortality OR of 8.5 (95% CI, 2.8-25.7). Limitations: This was an observational study; interventions were not standardized. The relationship between fluid overload and mortality remains an association without definitive evidence of causality. Conclusions: Critically ill children who develop greater fluid overload before initiation of CRRT experience higher mortality than those with less fluid overload. Further goal-directed research is required to accurately define optimal fluid overload thresholds for initiation of CRRT.
KW - Continuous renal replacement therapy (CRRT)
KW - acute kidney injury
KW - fluid overhead
KW - pediatric
UR - https://www.scopus.com/pages/publications/74449085121
U2 - 10.1053/j.ajkd.2009.10.048
DO - 10.1053/j.ajkd.2009.10.048
M3 - Article
C2 - 20042260
AN - SCOPUS:74449085121
SN - 0272-6386
VL - 55
SP - 316
EP - 325
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -