Fluid balance, diuretic use, and mortality in acute kidney injury

Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients. Using data from th...

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Published in:Clinical journal of the American Society of Nephrology Vol. 6; no. 5; p. 966
Main Authors: Grams, Morgan E, Estrella, Michelle M, Coresh, Josef, Brower, Roy G, Liu, Kathleen D
Format: Journal Article
Language:English
Published: United States 01.05.2011
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ISSN:1555-905X, 1555-905X
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Abstract Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients. Using data from the Fluid and Catheter Treatment Trial (FACTT), a multicenter, randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury (ALI), we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI, as defined by the AKI Network criteria. 306 patients developed AKI in the first 2 study days and were included in our analysis. There were 137 in the fluid-liberal arm and 169 in the fluid-conservative arm (P=0.04). Baseline characteristics were similar between groups. Post-AKI fluid balance was significantly associated with mortality in both crude and adjusted analysis. Higher post-AKI furosemide doses had a protective effect on mortality but no significant effect after adjustment for post-AKI fluid balance. There was no threshold dose of furosemide above which mortality increased. A positive fluid balance after AKI was strongly associated with mortality. Post-AKI diuretic therapy was associated with 60-day patient survival in FACTT patients with ALI; this effect may be mediated by fluid balance.
AbstractList Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients. Using data from the Fluid and Catheter Treatment Trial (FACTT), a multicenter, randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury (ALI), we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI, as defined by the AKI Network criteria. 306 patients developed AKI in the first 2 study days and were included in our analysis. There were 137 in the fluid-liberal arm and 169 in the fluid-conservative arm (P=0.04). Baseline characteristics were similar between groups. Post-AKI fluid balance was significantly associated with mortality in both crude and adjusted analysis. Higher post-AKI furosemide doses had a protective effect on mortality but no significant effect after adjustment for post-AKI fluid balance. There was no threshold dose of furosemide above which mortality increased. A positive fluid balance after AKI was strongly associated with mortality. Post-AKI diuretic therapy was associated with 60-day patient survival in FACTT patients with ALI; this effect may be mediated by fluid balance.
Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients.BACKGROUND AND OBJECTIVESManagement of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients.Using data from the Fluid and Catheter Treatment Trial (FACTT), a multicenter, randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury (ALI), we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI, as defined by the AKI Network criteria.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTSUsing data from the Fluid and Catheter Treatment Trial (FACTT), a multicenter, randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury (ALI), we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI, as defined by the AKI Network criteria.306 patients developed AKI in the first 2 study days and were included in our analysis. There were 137 in the fluid-liberal arm and 169 in the fluid-conservative arm (P=0.04). Baseline characteristics were similar between groups. Post-AKI fluid balance was significantly associated with mortality in both crude and adjusted analysis. Higher post-AKI furosemide doses had a protective effect on mortality but no significant effect after adjustment for post-AKI fluid balance. There was no threshold dose of furosemide above which mortality increased.RESULTS306 patients developed AKI in the first 2 study days and were included in our analysis. There were 137 in the fluid-liberal arm and 169 in the fluid-conservative arm (P=0.04). Baseline characteristics were similar between groups. Post-AKI fluid balance was significantly associated with mortality in both crude and adjusted analysis. Higher post-AKI furosemide doses had a protective effect on mortality but no significant effect after adjustment for post-AKI fluid balance. There was no threshold dose of furosemide above which mortality increased.A positive fluid balance after AKI was strongly associated with mortality. Post-AKI diuretic therapy was associated with 60-day patient survival in FACTT patients with ALI; this effect may be mediated by fluid balance.CONCLUSIONSA positive fluid balance after AKI was strongly associated with mortality. Post-AKI diuretic therapy was associated with 60-day patient survival in FACTT patients with ALI; this effect may be mediated by fluid balance.
Author Brower, Roy G
Grams, Morgan E
Coresh, Josef
Liu, Kathleen D
Estrella, Michelle M
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  surname: Brower
  fullname: Brower, Roy G
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  givenname: Kathleen D
  surname: Liu
  fullname: Liu, Kathleen D
BackLink https://www.ncbi.nlm.nih.gov/pubmed/21393482$$D View this record in MEDLINE/PubMed
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OpenAccessLink https://www.ncbi.nlm.nih.gov/pmc/articles/3087792
PMID 21393482
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PublicationDate 2011-May
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PublicationTitle Clinical journal of the American Society of Nephrology
PublicationTitleAlternate Clin J Am Soc Nephrol
PublicationYear 2011
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Snippet Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to...
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SubjectTerms Acute Kidney Injury - drug therapy
Acute Kidney Injury - metabolism
Acute Kidney Injury - mortality
Acute Lung Injury - drug therapy
Acute Lung Injury - metabolism
Acute Lung Injury - mortality
Critical Illness - mortality
Critical Illness - therapy
Diuretics - therapeutic use
Female
Fluid Therapy - methods
Fluid Therapy - mortality
Fluid Therapy - statistics & numerical data
Furosemide - therapeutic use
Humans
Male
Middle Aged
Multicenter Studies as Topic - statistics & numerical data
Proportional Hazards Models
Randomized Controlled Trials as Topic - statistics & numerical data
Water-Electrolyte Balance - drug effects
Water-Electrolyte Balance - physiology
Title Fluid balance, diuretic use, and mortality in acute kidney injury
URI https://www.ncbi.nlm.nih.gov/pubmed/21393482
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