Effect of fluid load on the prognosis of children with sepsis-associated acute kidney injury undergoing continuous renal replacement therapy
LAI Zhi-Jun, YANG Wen-Hai, MA Ke-Ze
Department of Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, Guangdong 523325, China
Abstract：Objective To evaluate the effect of fluid load on the prognosis of children with sepsis-associated acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). Methods A total of 121 children who underwent CRRT for sepsis-associated AKI from August 2018 to March 2021 were enrolled in the retrospective study. According to the fluid load from admission or disease progression to CRRT, they were divided into three groups: low fluid load (fluid load: <5%; n=35), high fluid load (fluid load: 5% - <10%; n=35), and fluid overload (fluid load: ≥10%; n=51). Baseline data and clinical biochemical data before CRRT were collected for comparison and analysis. The Kaplan-Meier survival curve analysis was used for comparison of 28-day survival between groups. The multivariate logistic regression model was used to identify the influencing factors for the prognosis of the children. Results The survival analysis showed that the fluid overload group had a significantly higher 28-day mortality rate than the low fluid load and high fluid load groups (P<0.05). The multivariate logistic regression analysis showed that an increase in fluid overload volume was a risk factor for increased 28-day mortality in the fluid overload group, while earlier initiation of CRRT was a protective factor (P<0.05). Conclusions Fluid overload before CRRT may increase the mortality in children with sepsis-associated AKI, and CRRT should be performed for these children as early as possible.
LAI Zhi-Jun,YANG Wen-Hai,MA Ke-Ze. Effect of fluid load on the prognosis of children with sepsis-associated acute kidney injury undergoing continuous renal replacement therapy[J]. CJCP, 2022, 24(3): 279-284.
Wang YY, Sun B, Yue HN, et al. An epidemiologic survey of pediatric sepsis in regional hospitals in China[J]. Pediatr Crit Care Med, 2014, 15(9): 814-820. PMID: 25226498. DOI: 10.1097/PCC.0000000000000247.
Selewski DT, Goldstein SL. The role of fluid overload in the prediction of outcome in acute kidney injury[J]. Pediatr Nephrol, 2018, 33(1): 13-24. PMID: 27900473. DOI: 10.1007/s00467-016-3539-6.
Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children[J]. Intensive Care Med, 2020, 46(Suppl 1): 10-67. PMID: 32030529. PMCID: PMC7095013. DOI: 10.1007/s00134-019-05878-6.
Woodward CW, Lambert J, Ortiz-Soriano V, et al. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy[J]. Crit Care Med, 2019, 47(9): e753-e760. PMID: 31162196. DOI: 10.1097/CCM.0000000000003862.
Muttath A, Annayappa Venkatesh L, Jose J, et al. Adverse outcomes due to aggressive fluid resuscitation in children: a prospective observational study[J]. J Pediatr Intensive Care, 2019, 8(2): 64-70. PMID: 31093457. PMCID: PMC6517050. DOI: 10.1055/s-0038-1667009.
Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry[J]. Am J Kidney Dis, 2010, 55(2): 316-325. PMID: 20042260. DOI: 10.1053/j.ajkd.2009.10.048.
Modem V, Thompson M, Gollhofer D, et al. Timing of continuous renal replacement therapy and mortality in critically ill children*[J]. Crit Care Med, 2014, 42(4): 943-953. PMID: 24231758. DOI: 10.1097/CCM.0000000000000039.
Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial[J]. JAMA, 2016, 315(20): 2190-2199. PMID: 27209269. DOI: 10.1001/jama.2016.5828.
Barbar SD, Clere-Jehl R, Bourredjem A, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis[J]. N Engl J Med, 2018, 379(15): 1431-1442. PMID: 30304656. DOI: 10.1056/NEJMoa1803213.
Bagshaw SM, Wald R, Adhikari NKJ, et al. Timing of initiation of renal-replacement therapy in acute kidney injury[J]. N Engl J Med, 2020, 383(3): 240-251. PMID: 32668114. DOI: 10.1056/NEJMoa2000741.
15 Fang JJ, Wang MJ, Gong SJ, et al. Increased 28-day mortality due to fluid overload prior to continuous renal replacement in sepsis associated acute kidney injury[J]. Ther Apher Dial, 2021. PMID: 34436823. DOI: 10.1111/1744-9987.13727. Epub ahead of print.
Lin J, Ji XJ, Wang AY, et al. Timing of continuous renal replacement therapy in severe acute kidney injury patients with fluid overload: a retrospective cohort study[J]. J Crit Care, 2021, 64: 226-236. PMID: 34034218. DOI: 10.1016/j.jcrc.2021.04.017.
Lee ST, Cho H. Fluid overload and outcomes in neonates receiving continuous renal replacement therapy[J]. Pediatr Nephrol, 2016, 31(11): 2145-2152. PMID: 26975386. DOI: 10.1007/s00467-016-3363-z.
