Early RRT !
A positive fluid balance is associated with a worse outcome in patients with acute renal failure
Another study showing that a positive fluid balance is associated with a worse outcome in patients with acute renal failure and favouring early renal replacement therapy (RRT).
Introduction : Despite significant improvements in intensive care medicine, the prognosis of acute renal failure (ARF) remains poor, with mortality ranging from 40 to 65%. The aim of the study was to analyze the influence of patient characteristics and fluid balance on the outcome of ARF in intensive care unit (ICU) patients.
Methods: The data were extracted from the Sepsis Occurrence in Acutely Ill patients (SOAP) study, a multicenter observational cohort study to which 198 ICUs from 24 European countries contributed. For the purposes of this substudy, patients were divided into two groups according to whether or not they had ARF.
The groups were compared with respect to patient characteristics, fluid balance, and outcome.
Results
- Sixty-day mortality was 36% in patients with ARF and 16% in patients without ARF
- Oliguric patients and patients treated with renal replacement therapy (RRT) had higher 60-day mortality rates than patients without oliguria or the need for RRT (41 vs 33% and 52 vs 32%, respectively)
- Independent risk factors for 60-day mortality in the patients with ARF were age, Simplified Acute Physiology Score (SAPS) II, heart failure, liver cirrhosis, medical admission, mean fluid balance, and need for mechanical ventilation.
- Among patients treated with RRT, length of stay and mortality were lower when RRT was started early in the course of the ICU stay.
Conclusions: A positive fluid balance was an important factor associated with increased 60-day mortality. Outcome among patients treated with RRT was better when RRT was started early in the course of the ICU stay.
Reference: click to get abstract
A positive fluid balance is associated with a worse outcome in patients with acute renal failure - Critical Care 2008, 12:R74 - Full provisional PDF article is available at abstract page
