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Cumulative fluid balance and mortality in elderly patients with acute kidney injury requiring continuous renal-replacement therapy: a multicenter prospective cohort study

Kidney Research and Clinical Practice 2020년 39권 4호 p.414 ~ 425
지종현, 박재윤, 안정남, 김동기, 주권욱, 오윤규, 임춘수, 김연수, 한승혁, 유태현, 강신욱, 이정표, 박정탁,
소속 상세정보
지종현 ( Jhee Jong-Hyun ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Internal Medicine
박재윤 ( Park Jae-Yoon ) - Dongguk University Ilsan Hospital Department of Internal Medicine
안정남 ( An Jung-Nam ) - Seoul National University Boramae Medical Center Department of Internal Medicine
김동기 ( Kim Dong-Ki ) - Seoul National University College of Medicine Department of Internal Medicine
주권욱 ( Joo Kwon-Wook ) - Seoul National University College of Medicine Department of Internal Medicine
오윤규 ( Oh Yun-Kyu ) - Seoul National University College of Medicine Department of Internal Medicine
임춘수 ( Lim Chun-Soo ) - Seoul National University College of Medicine Department of Internal Medicine
김연수 ( Kim Yon-Su ) - Seoul National University College of Medicine Department of Internal Medicine
한승혁 ( Han Seung-Hyeok ) - Yonsei University College of Medicine Department of Internal Medicine
유태현 ( Yoo Tae-Hyun ) - Yonsei University College of Medicine Department of Internal Medicine
강신욱 ( Kang Shin-Wook ) - Yonsei University College of Medicine Department of Internal Medicine
이정표 ( Lee Jung-Pyo ) - Seoul National University College of Medicine Department of Internal Medicine
박정탁 ( Park Jung-Tak ) - Yonsei University College of Medicine Department of Internal Medicine

Abstract


Background: The effect of fluid balance on outcomes in elderly patients with acute kidney injury (AKI) requiring continuous renal-replacement therapy (CRRT) is not explained well. We investigated outcomes according to cumulative fluid balance (CFB) in elderly patients with AKI undergoing CRRT.

Methods: A total of 607 patients aged 65 years or older who started CRRT due to AKI were enrolled and stratified into two groups (fluid overload [FO] vs. no fluid overload [NFO]) based on the median CFB value for 72 hours before CRRT initiation. Propensity score-matching analysis was performed.

Results: The median age of included patients was 73.0 years and 60.0% of the population was male. The median 72-hour CFB value was 2,839.0 mL. The overall cumulative survival and 28-day survival rates were lower in the FO group than in the NFO group (P < 0.001 for both) and remained so after propensity score-matching. Furthermore, patients in the FO group demonstrated a higher overall mortality risk after adjustment for age, sex, systolic blood pressure, Charlson comorbidity index, Acute Physiology and Chronic Health Evaluation II score, serum albumin, creatinine, diuretic use, and mechanical ventilation status (hazard ratio, 1.38; 95% confidence interval, 1.13 to 1.89; P < 0.001). Among survivors, both the duration of CRRT and the total duration of hospitalization from CRRT initiation showed no difference between the FO and NFO groups.

Conclusion: A higher CFB value is associated with an increased risk of mortality in elderly patients with AKI requiring CRRT.

키워드

Acute kidney injury; Aged; Continuous renal-replacement therapy; Cumulative fluid balance; Survival

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