. 2011 Dec;39(12):2665-71.

doi: 10.1097/CCM.0b013e318228234b.

Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes

Kathleen D Liu¹, B Taylor Thompson, Marek Ancukiewicz, Jay S Steingrub, Ivor S Douglas, Michael A Matthay, Patrick Wright, Michael W Peterson, Peter Rock, Robert C Hyzy, Antonio Anzueto, Jonathon D Truwit; National Institutes of Health National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network

Collaborators, Affiliations

Collaborators

National Institutes of Health National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network:
G R Bernard, D A Schoenfeld, B T Thompson, N Ringwood, C Oldmixon, F Molay, A Korpak, R Morse, D Hayden, M Ancukiewicz, A Minihan, J G N Garcia, R Balk, S Emerson, M Shasby, W Sibbald, R Spragg, G Corbie-Smith, J Kelley, K Leeper, A S Slutsky, B Turnbull, C Vreim, A L Harabin, D Gail, P Lew, M Waclawiw, P Parsons, L Hudson, K Steinberg, M Neff, R Maier, K Sims, C Cooper, T Berry-Bell, G Carter, L Andersson, G B Toews, R H Bartlett, C Watts, R Hyzy, D Arnoldi, R Dechert, M Purple, H Silverman, C Shanholtz, A Moore, L Heinrich, W Corral, R Brower, D Thompson, H Fessler, S Murray, A Sculley, H P Wiedemann, A C Arroliga, J Komara, T Isabella, M Ferrari, J Kern, R Hejal, D Haney, A F Connors, E Abraham, R McIntyre, F Piedalue, C Welsh, I Douglas, R Wolkin, T Bost, B Sagel, A Hawkes, N MacIntyre, J Govert, W Fulkerson, L Mallatrat, L Brown, S Everett, E VanDyne, N Knudsen, M Gentile, P Rock, S Carson, C Schuler, L Baker, V Salo, A P Wheeler, G Bernard, T Rice, B Christman, S Bozeman, T Welch, P Lanken, J Christie, B Fuchs, B Finkel, S Kaplan, V Gracias, C W Hanson, P Reilly, M B Shapiro, R Burke, E O'Connor, D Wolfe, J Gottlieb, P Park, D M Dillon, A Girod, J Furlong, A Morris, C Grissom, L Weaver, J Orme, T Clemmer, R Davis, J Gleed, S Pies, T Graydon, S Anderson, K Bennion, P Skinner, C Lawton, J d'Hulst, D Hanselman, K Sundar, T Hill, K Ludwig, D Nielson, M A Matthay, M Eisner, B Daniel, O Garcia, J Luce, R Kallet, M Peterson, J Lanford, K Guntupalli, V Bandi, C Pope, J Steingrub, M Tidswell, L Kozikowski, B deBoisblanc, J Hunt, C Glynn, P Lauto, G Meyaski, C Romaine, S Brierre, C LeBlanc, K Reed, D Taylor, C Thompson, F Simeone, M Johnston, M Wright, G Schmidt, J Hall, S Hemmann, B Gehlbach, A Vinayak, W Schweickert, J Dematte D'Amico, H Donnelly, A Anzueto, J McCarthy, S Kucera, J Peters, T Houlihan, R Steward, D Vines, J D Truwit, A F Connors, M H Marshall, W Matsumura, R Brett, M Donahoe, P Linden, J Puyana, L Lucht, A Verno, R D Hite, P Morris, A Howard, A Nesser, S Perez, P Wright, C Carter-Cole, J McLean, J Russell, L Lazowski, K Foley, D Chittock, L Grandolfo, M Murray

Affiliation

¹ Division of Nephrology, University of California San Francisco, San Francisco, CA, USA.

PMID: 21785346
PMCID: PMC3220741
DOI: 10.1097/CCM.0b013e318228234b

Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes

Kathleen D Liu et al. Crit Care Med. 2011 Dec.

. 2011 Dec;39(12):2665-71.

doi: 10.1097/CCM.0b013e318228234b.

Authors

Collaborators

National Institutes of Health National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network:
G R Bernard, D A Schoenfeld, B T Thompson, N Ringwood, C Oldmixon, F Molay, A Korpak, R Morse, D Hayden, M Ancukiewicz, A Minihan, J G N Garcia, R Balk, S Emerson, M Shasby, W Sibbald, R Spragg, G Corbie-Smith, J Kelley, K Leeper, A S Slutsky, B Turnbull, C Vreim, A L Harabin, D Gail, P Lew, M Waclawiw, P Parsons, L Hudson, K Steinberg, M Neff, R Maier, K Sims, C Cooper, T Berry-Bell, G Carter, L Andersson, G B Toews, R H Bartlett, C Watts, R Hyzy, D Arnoldi, R Dechert, M Purple, H Silverman, C Shanholtz, A Moore, L Heinrich, W Corral, R Brower, D Thompson, H Fessler, S Murray, A Sculley, H P Wiedemann, A C Arroliga, J Komara, T Isabella, M Ferrari, J Kern, R Hejal, D Haney, A F Connors, E Abraham, R McIntyre, F Piedalue, C Welsh, I Douglas, R Wolkin, T Bost, B Sagel, A Hawkes, N MacIntyre, J Govert, W Fulkerson, L Mallatrat, L Brown, S Everett, E VanDyne, N Knudsen, M Gentile, P Rock, S Carson, C Schuler, L Baker, V Salo, A P Wheeler, G Bernard, T Rice, B Christman, S Bozeman, T Welch, P Lanken, J Christie, B Fuchs, B Finkel, S Kaplan, V Gracias, C W Hanson, P Reilly, M B Shapiro, R Burke, E O'Connor, D Wolfe, J Gottlieb, P Park, D M Dillon, A Girod, J Furlong, A Morris, C Grissom, L Weaver, J Orme, T Clemmer, R Davis, J Gleed, S Pies, T Graydon, S Anderson, K Bennion, P Skinner, C Lawton, J d'Hulst, D Hanselman, K Sundar, T Hill, K Ludwig, D Nielson, M A Matthay, M Eisner, B Daniel, O Garcia, J Luce, R Kallet, M Peterson, J Lanford, K Guntupalli, V Bandi, C Pope, J Steingrub, M Tidswell, L Kozikowski, B deBoisblanc, J Hunt, C Glynn, P Lauto, G Meyaski, C Romaine, S Brierre, C LeBlanc, K Reed, D Taylor, C Thompson, F Simeone, M Johnston, M Wright, G Schmidt, J Hall, S Hemmann, B Gehlbach, A Vinayak, W Schweickert, J Dematte D'Amico, H Donnelly, A Anzueto, J McCarthy, S Kucera, J Peters, T Houlihan, R Steward, D Vines, J D Truwit, A F Connors, M H Marshall, W Matsumura, R Brett, M Donahoe, P Linden, J Puyana, L Lucht, A Verno, R D Hite, P Morris, A Howard, A Nesser, S Perez, P Wright, C Carter-Cole, J McLean, J Russell, L Lazowski, K Foley, D Chittock, L Grandolfo, M Murray

Affiliation

¹ Division of Nephrology, University of California San Francisco, San Francisco, CA, USA.

PMID: 21785346
PMCID: PMC3220741
DOI: 10.1097/CCM.0b013e318228234b

Abstract

Objective: It has been suggested that fluid accumulation may delay recognition of acute kidney injury. We sought to determine the impact of fluid balance on the incidence of nondialysis requiring acute kidney injury in patients with acute lung injury and to describe associated outcomes, including mortality.

Design: Analysis of the Fluid and Catheter Treatment Trial, a factorial randomized clinical trial of conservative vs. liberal fluid management and of management guided by a central venous vs. pulmonary artery catheter.

Setting: Acute Respiratory Distress Syndrome Network hospitals.

Patients: One thousand patients.

Interventions: None.

Measurements and main results: The incidence of acute kidney injury, defined as an absolute rise in creatinine of ≥0.3 mg/dL or a relative change of >50% over 48 hrs, was examined before and after adjustment of serum creatinine for fluid balance. The incidence of acute kidney injury before adjustment for fluid balance was greater in those managed with the conservative fluid protocol (57% vs. 51%, p = .04). After adjustment for fluid balance, the incidence of acute kidney injury was greater in those managed with the liberal fluid protocol (66% vs. 58%, p = .007). Patients who met acute kidney injury criteria after adjustment of creatinine for fluid balance (but not before) had a mortality rate that was significantly greater than those who did not meet acute kidney injury criteria both before and after adjustment for fluid balance (31% vs. 12%, p < .001) and those who had acute kidney injury before but not after adjustment for fluid balance (31% vs. 11%, p = .005). The mortality of those patients meeting acute kidney injury criteria after but not before adjustment for fluid balance was similar to patients with acute kidney injury both before and after adjustment for fluid balance (31% vs. 38%, p = .18).

Conclusions: Fluid management influences serum creatinine and therefore the diagnosis of acute kidney injury using creatinine-based definitions. Patients with "unrecognized" acute kidney injury that is identified after adjusting for positive fluid balance have higher mortality rates, and patients who have acute kidney injury before but not after adjusting for fluid balance have lower mortality rates. Future studies of acute kidney injury should consider potential differences in serum creatinine caused by changes in fluid balance and the impact of these differences on diagnosis and prognosis.

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Figures

**Figure 1**
Impact of adjustment of serum creatinine for fluid balance on the ascertainment of AKI.

See this image and copyright information in PMC

Comment in

Timing of fluid administration in critically ill patients with acute kidney injury: every good thing has an end.
Rachoin JS, Kellum JA. Rachoin JS, et al. Crit Care Med. 2011 Dec;39(12):2766-7. doi: 10.1097/CCM.0b013e31822b3885. Crit Care Med. 2011. PMID: 22094508 No abstract available.

References

1. Wheeler AP, Bernard GR, Thompson BT, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med. 2006;354(21):2213–2224. - PubMed
1. Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–2575. - PubMed
1. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–1693. - PubMed
1. Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. Jama. 2010;303(9):865–873. - PubMed
1. Liu KD, Glidden DV, Eisner MD, et al. Predictive and Pathogenetic Value of Plasma Biomarkers for Acute Kidney Injury In Patients with Acute Lung Injury. Crit Care Med. 2007;35:2755–2761. - PMC - PubMed

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Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes

Collaborators

Affiliation

Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes

Authors

Collaborators

Affiliation

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous