Fluid overload at start of continuous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combined use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement

• Published in: Critical care (London, England) England), 2015-04, Vol.19 (1), p.135-135, Article 135
• Main Authors: Chen, Haiyan, Wu, Buyun, Gong, Dehua, Liu, Zhihong
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - metabolism; Acute Kidney Injury - therapy; Adult; Analysis; Body Water - metabolism; Critical care; Critical Illness; Female; Health aspects; Heart failure; Hemoglobin; Hemoglobins - metabolism; Humans; Intensive Care Units; Kidneys; Male; Measurement; Middle Aged; Monitoring, Physiologic - instrumentation; Mortality; Natriuretic Peptide, Brain - blood; Natriuretic peptides; Observational studies; Peptide Fragments - blood; Peptides; Peritoneal dialysis; Physiology; Predictive Value of Tests; Prognosis; Prospective Studies; Renal replacement therapy; Renal Replacement Therapy - mortality
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-015-0871-3

It is unclear whether the fluid status, as determined by bioimpedance vector analysis (BIVA) combined with serum N-terminal pro-B-type natriuretic peptides (NT-pro-BNP) measurement, is associated with treatment outcome among patients receiving continuous renal replacement therapy (CRRT). Our objective was to answer this question. Patients who were in the intensive care units of a university teaching hospital and who required CRRT were screened for enrollment. For the enrolled patients, BIVA and serum NT-pro BNP measurement were performed just before the start of CRRT and 3 days afterward. According to the BIVA and NT-pro BNP measurement results, the patients were divided into four groups according to fluid status type: type 1, both normal; type 2, normal BIVA results and abnormal NT-pro BNP levels; type 3, abnormal BIVA results and normal NT-pro BNP levels; and type 4, both abnormal. The associations between fluid status and outcome were analyzed. Eighty-nine patients were enrolled, 58 were males, and the mean age was 49.0 ± 17.2 years. The mean score of Acute Physiology and Chronic Health Evaluation II (APACHE II) was 18.8 ± 8.6. The fluid status before CRRT start was as follows: type 1, 21.3% (19 out of 89); type 2, 16.9% (15 out of 89); type 3, 11.2% (10 out of 89); and type 4, 50.6% (45 out of 89). There were significant differences between fluid status types before starting CRRT on baseline values for APACHE II scores, serum creatinine, hemoglobin, platelet count, urine volume, and incidences of oliguria and acute kidney injury (P