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Observational Study
. 2012 Oct 17;16(5):R197.
doi: 10.1186/cc11682.

Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study

Suvi T Vaara, Anna-Maija Korhonen, Kirsi-Maija Kaukonen, Sara Nisula, Outi Inkinen, Sanna Hoppu, Jouko J Laurila, Leena Mildh, Matti Reinikainen, Vesa Lund, Ilkka Parviainen, Ville Pettilä; FINNAKI Study Group
Collaborators
Observational Study

Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study

Suvi T Vaara et al. Crit Care. .

Abstract

Introduction: Positive fluid balance has been associated with an increased risk for mortality in critically ill patients with acute kidney injury with or without renal replacement therapy (RRT). Data on fluid accumulation prior to RRT initiation and mortality are limited. We aimed to study the association between fluid accumulation at RRT initiation and 90-day mortality.

Methods: We conducted a prospective, multicenter, observational cohort study in 17 Finnish intensive care units (ICUs) during a five-month period. We collected data on patient characteristics, RRT timing, and parameters at RRT initiation. We studied the association of parameters at RRT initiation, including fluid overload (defined as cumulative fluid accumulation > 10% of baseline weight) with 90-day mortality.

Results: We included 296 RRT-treated critically ill patients. Of 283 patients with complete data on fluid balance, 76 (26.9%) patients had fluid overload. The median (interquartile range) time from ICU admission to RRT initiation was 14 (3.3 to 41.5) hours. The 90-day mortality rate of the whole cohort was 116 of 296 (39.2%; 95% confidence interval 38.6 to 39.8%). The crude 90-day mortality of patients with or without fluid overload was 45 of 76 (59.2%) vs. 65 of 207 (31.4%), P < 0.001. In logistic regression, fluid overload was associated with an increased risk for 90-day mortality (odds ratio 2.6) after adjusting for disease severity, time of RRT initiation, initial RRT modality, and sepsis. Of the 168 survivors with data on RRT use at 90 days, 34 (18.9%, 95% CI 13.2 to 24.6%) were still dependent on RRT.

Conclusions: Patients with fluid overload at RRT initiation had twice as high crude 90-day mortality compared to those without. Fluid overload was associated with increased risk for 90-day mortality even after adjustments.

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Figures

Figure 1
Figure 1
Study flow chart with 90-day mortality rates. *ICU, intensive care unit; RRT, renal replacement therapy.
Figure 2
Figure 2
Kaplan-Meier unadjusted survival curves for 90-day survival in patients with or without fluid overload. *Number of patients with fluid overload 76 and without fluid overload 207.
Figure 3
Figure 3
Ninety-day mortality according to the percentage of fluid accumulation prior to renal replacement therapy initiation. *Comparison across groups P < 0.001.
See this image and copyright information in PMC

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