Publication: Early net ultrafiltration rate and mortality in critically ill patients receiving continuous renal replacement therapy
Issued Date
2021-06-01
Resource Type
ISSN
14602385
09310509
09310509
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2-s2.0-85107163431
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Mahidol University
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SCOPUS
Bibliographic Citation
Nephrology Dialysis Transplantation. Vol.36, No.6 (2021), 1112-1119
Suggested Citation
Thummaporn Naorungroj, Ary Serpa Neto, Lara Zwakman-Hessels, Fumitaka Yanase, Glenn Eastwood, Raghavan Murugan, John A. Kellum, Rinaldo Bellomo Early net ultrafiltration rate and mortality in critically ill patients receiving continuous renal replacement therapy. Nephrology Dialysis Transplantation. Vol.36, No.6 (2021), 1112-1119. doi:10.1093/ndt/gfaa032 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78156
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Title
Early net ultrafiltration rate and mortality in critically ill patients receiving continuous renal replacement therapy
Other Contributor(s)
Siriraj Hospital
University of Melbourne
Hospital Israelita Albert Einstein
Faculty of Medicine, Nursing and Health Sciences
Universitair Medisch Centrum Groningen
Austin Hospital
University of Pittsburgh School of Medicine
Amsterdam UMC - University of Amsterdam
Data Analytics Research and Evaluation Centre
University of Melbourne
Hospital Israelita Albert Einstein
Faculty of Medicine, Nursing and Health Sciences
Universitair Medisch Centrum Groningen
Austin Hospital
University of Pittsburgh School of Medicine
Amsterdam UMC - University of Amsterdam
Data Analytics Research and Evaluation Centre
Abstract
Background: In patients treated with continuous renal replacement therapy (CRRT), early net ultrafiltration (NUF) rates may be associated with differential outcomes. We tested whether higher early NUF rates are associated with increased mortality in CRRT patients. Methods: We performed a retrospective, observational study of all patients treated with CRRT within 14 days of intensive care unit admission. We defined the early (first 48 h) NUF rate as the volume of fluid removed per hour adjusted for patient body weight and analysed as a categorical variable (>1.75, 1.01-1.75 and <1.01 mL/kg/h). The primary outcome was 28-day mortality. To deal with competing risk, we also compared different time epochs. Results: We studied 347 patients {median age 64 [interquartile range (IQR) 53-71] years and Acute Physiology and Chronic Health Evaluation III score 73 [IQR 54-90]}. Compared with NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h were associated with greater mortality rates in each epoch: Days 0-5, adjusted hazard ratio (aHR) 1.27 [95% confidence interval (CI) 1.21-1.33]; Days 6-10, aHR 1.62 (95% CI 1.55-1.68); Days 11-15, aHR 1.87 (95% CI 1.79-1.94); Days 16-26, aHR 1.92 (95% CI 1.84-2.01) and Days 27-28, aHR 4.18 (95% CI 3.98-4.40). For every 0.5 mL/kg/h NUF rate increase, mortality similarly increased during these epochs. Conclusion: Compared with early NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h are associated with increased mortality. These observations provide the rationale for clinical trials to confirm or refute these findings.