Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury

被引:148
作者
Heung, Michael [1 ]
Wolfgram, Dawn F. [2 ]
Kommareddi, Mallika [1 ]
Hu, Youna [3 ]
Song, Peter X. [3 ]
Ojo, Akinlolu O. [1 ]
机构
[1] Univ Michigan, Dept Med, Div Nephrol, Ann Arbor, MI 48109 USA
[2] Univ Wisconsin, Dept Med, Div Nephrol, Madison, WI USA
[3] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA
关键词
acute kidney injury; dialysis; fluid overload; renal recovery; CRITICALLY-ILL PATIENTS; LONG-TERM OUTCOMES; CLINICAL-TRIAL; FAILURE; SURVIVAL; HEMOFILTRATION; RESTRICTION; DIALYSIS; HEMODIALYSIS; MULTICENTER;
D O I
10.1093/ndt/gfr470
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Patients with acute kidney injury (AKI) requiring initiation of renal replacement therapy (RRT) have poor short- and long-term outcomes, including the development of dialysis dependence. Currently, little is known about what factors may predict renal recovery in this population. Methods. We conducted a single-center, retrospective analysis of 170 hospitalized adult patients with AKI attributed to acute tubular necrosis who required inpatient initiation of RRT. Data collection included patient characteristics, laboratory data, details of hospital course and degree of fluid overload at RRT initiation. The primary outcome was recovery of renal function to dialysis independence. Results. Within 1 year of RRT initiation, 35.9% (61/170) of patients reached the primary end point of renal recovery. The median (interquartile range) duration of RRT was 1 I (3-33) days and 83.6% (51/61) recovered prior to hospital discharge. Recovering patients had significantly less fluid overload at the time of RRT initiation compared to non-recovering patients (3.5 versus 9.3%, P = 0.004). In multivariate Cox proportional hazard regression analysis, a rise in percent fluid overload at dialysis initiation remained a significant negative predictor of renal recovery (hazard ratio 0.97, 95% confidence interval 0.95-1.00, P = 0.024). Conclusions. In patients with AM, a higher degree of fluid overload at RRT initiation predicts worse renal recovery at 1 year. Clinical trials are needed to determine whether interventions targeting fluid overload may improve patient and renal outcomes.
引用
收藏
页码:956 / 961
页数:6
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