Outcomes from a cohort of patients with acute kidney injury subjected to continuous venovenous hemodiafiltration: The role of negative fluid balance

• Published in: PloS one 2017-04, Vol.12 (4), p.e0175897-e0175897
• Main Authors: Dos Santos, Thais Oliveira Claizoni, Oliveira, Marisa Aparecida de Souza, Monte, Julio Cesar Martins, Batista, Marcelo Costa, Pereira Junior, Virgilio Gonçalves, Dos Santos, Bento Fortunato Cardoso, Santos, Oscar Fernando Pavão, Durão Junior, Marcelino de Souza
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - physiopathology; Acute Kidney Injury - therapy; Aged; Biology and Life Sciences; Blood volume; Cardiovascular diseases; Chronic obstructive pulmonary disease; Cirrhosis; Clinical trials; Cohort Studies; Diabetes mellitus; Dialysis; Female; Hemodiafiltration - methods; Hemodialysis; Hospital Mortality; Hospitals; Humans; Hypertension; Intensive care; Intensive Care Units; Kidney diseases; Kidney Function Tests; Kidneys; Liver cirrhosis; Lung diseases; Male; Malignancy; Medical prognosis; Medicine and Health Sciences; Metabolism; Middle Aged; Mortality; Nephrology; Obstructive lung disease; Patient Discharge; Patients; People and Places; Prospective Studies; Renal replacement therapy; Risk analysis; Risk factors; Sepsis; Transplants & implants; Treatment Outcome; Ventilators; Water-Electrolyte Balance
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0175897

Several factors influence the outcomes in acute kidney injury (AKI), especially in intensive care unit (ICU) patients. In this scenario, continuous renal replacement therapies (CRRT) are used to control metabolic derangements and blood volume. Knowing this fact, it may be possible to change the course of the disease and decrease the high mortality rate observed. Thus, we aimed to evaluate the main risk factors for death in AKI patients needing CRRT. This was a prospective, observational cohort study of ICU patients (N = 183) with AKI who underwent continuous venovenous hemodiafiltration (CVVHDF) as their initial dialysis modality choice. The patients were predominantly male (62.8%) and their median age was 65 (55-76) years. The most frequent comorbidities were cardiovascular disease (39.3%), hypertension (32.8%), diabetes (24%), and cirrhosis (20.7%). The main cause of AKI was sepsis (52.5%). At beginning of CVVHDF, 152 patients (83%) were using vasopressors. The median SAPS 3 and SOFA score at ICU admission was 61 (50-74) and 10 (7-12), respectively. The dialysis dose delivered was 33.2 (28.9-38.7) ml/kg/h. The median time between ICU admission and CVVHDF initiation was 2 (1-4) days. The median cumulative fluid balance during the CVVHDF period was -1838 (-5735 +2993) ml. The mortality rate up to90 days was 58%. The independent mortality risk factors in propensity score model were: chronic obstructive pulmonary disease (OR = 3.44[1.14-10.4; p = 0.028]), hematologic malignancy (OR = 5.14[1.66-15.95; p = 0.005]), oliguria (OR = 2.36[1.15-4.9; p = 0.02]), positive daily fluid balance during CVVHDF (OR = 4.55[2.75-13.1; p