Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury
Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury
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DOI：
10.1038/ki.2009.159
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发表时间：
2009-08-01
影响因子：
19.6
通讯作者：
Mehta, Ravindra L.
中科院分区：
文献类型：
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作者：
Bouchard, Josee;Soroko, Sharon B.;Mehta, Ravindra L.
体液积聚与危重病人的不良结局有关。在这里，我们试图确定液体堆积是否与急性肾损伤的危重成人的死亡率和肾功能无法恢复有关。液体超负荷被定义为体重相对于基线增加超过10%，在一项前瞻性多中心观察性研究中对618名患者进行了测量。液体超负荷的患者在登记的60天内经历了显著更高的死亡率。在透析患者中，在调整了透析方式和严重程度评分后，在开始透析时，幸存者的液体蓄积量显著低于非幸存者。调整后的优势比为2.07与透析开始时液体超负荷相关的死亡。在未透析的患者中，幸存者在其血清肌酐峰值时的液体积聚显著减少。急性肾损伤诊断时液体超载与肾功能恢复无关。然而，当血清肌酐达到峰值时，液体超负荷的患者恢复肾功能的可能性明显降低。我们的研究表明，在急性肾损伤患者中，液体超载与死亡率独立相关。液体超载是由更严重的肾功能衰竭造成的，还是其原因之一，将需要临床试验，在临床试验中，直接测试对这类患者的液体供应的作用。
Fluid accumulation is associated with adverse outcomes in critically ill patients. Here, we sought to determine if fluid accumulation is associated with mortality and non-recovery of kidney function in critically ill adults with acute kidney injury. Fluid overload was defined as more than a 10% increase in body weight relative to baseline, measured in 618 patients enrolled in a prospective multicenter observational study. Patients with fluid overload experienced significantly higher mortality within 60 days of enrollment. Among dialyzed patients, survivors had significantly lower fluid accumulation when dialysis was initiated compared to non-survivors after adjustments for dialysis modality and severity score. The adjusted odds ratio for death associated with fluid overload at dialysis initiation was 2.07. In non-dialyzed patients, survivors had significantly less fluid accumulation at the peak of their serum creatinine. Fluid overload at the time of diagnosis of acute kidney injury was not associated with recovery of kidney function. However, patients with fluid overload when their serum creatinine reached its peak were significantly less likely to recover kidney function. Our study shows that in patients with acute kidney injury, fluid overload was independently associated with mortality. Whether the fluid overload was the result of a more severe renal failure or it contributed to its cause will require clinical trials in which the role of fluid administration to such patients is directly tested.