Fluid accumulation tied to major adverse kidney events in critically ill patients: Study

This association was shown to be independent of pre-existing chronic kidney disease (CKD) and strongest in patients with acute kidney injury (AKI) stage 3.

In critically ill patients, fluid management is a critical aspect of care, particularly those in intensive care units (ICUs). While fluid resuscitation is often necessary to stabilize hemodynamics and organ perfusion, excessive fluid accumulation can lead to complications, including AKI.

Fluid accumulation (FA) is known to be associated with acute kidney injury during ICU stay but data is scarce on mid-term renal outcome. Debora M. Hofer, Bern University Hospital, Bern, Switzerland, and colleagues aimed to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission.

For this purpose, the researchers conducted a retrospective, single-center cohort study comprising adult ICU patients with sufficient data to compute FA and MAKE30. Fluid accumulation was defined as a positive cumulative fluid balance greater than 5% of body weight.

The researchers examined the association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay. In addition, they performed a sensitivity analysis for the stage of AKI and the presence of CKD.

The study revealed the following findings:

• Out of 13,326 included patients, 8.3% met the FA definition.
• FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96) and all sub-components: need for renal replacement therapy (aOR 3.83), persistent renal dysfunction (aOR 1.72), and 30-day mortality (aOR 1.70).
• The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3.
• FA was independently associated with the creatinine trajectory over the whole observation period.

In the study, fluid accumulation was independently associated with MAKE30 in a mixed cohort of critically ill patients. The association was independent of pre-existing CKD and strongest in patients with AKI stage 3. FA independently and substantially affects short- and mid-term creatinine trajectory over 3 or 30 days following ICU admission.

"This may hint towards FA being a major risk factor for reduced renal recovery and patients with FA, particularly those with severe acute kidney should be considered “at risk” for renal recovery. There is no clarity on its therapeutic relevance for kidney-independent ICU outcomes," the researchers wrote. "Further high-quality investigations are needed."

Reference:

Hofer, D. M., Ruzzante, L., Waskowski, J., Messmer, A. S., & Pfortmueller, C. A. (2024). Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study. Annals of Intensive Care, 14(1), 1-10. https://doi.org/10.1186/s13613-024-01281-7