National Kidney Foundation Spring Clinical Meetings

National Kidney Foundation Spring Clinical Meetings

Issue: May 2022
Source:

Tolwani RK. When to initiate RRT for fluid management in critically ill patients with AKI? Presented at: National Kidney Foundation Spring Clinical Meetings; April 5-10, 2022; Boston.

Disclosures: Tolwani reports consulting and speaking for Baxter, and reports having a patent on 0.5% citrate anticoagulation solution for continuous renal replacement therapy.
April 07, 2022
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Speaker: Fluid overload greater than 10% of body weight correlates with AKI, mortality

Issue: May 2022
Source:

Tolwani RK. When to initiate RRT for fluid management in critically ill patients with AKI? Presented at: National Kidney Foundation Spring Clinical Meetings; April 5-10, 2022; Boston.

Disclosures: Tolwani reports consulting and speaking for Baxter, and reports having a patent on 0.5% citrate anticoagulation solution for continuous renal replacement therapy.
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BOSTON — Several studies indicate that fluid overload greater than 10% of body weight among patients is associated with AKI and mortality, according to a speaker at the National Kidney Foundation Spring Clinical Meetings.

“We all know that potentially adverse effects of fluid overload can constitute edema,” Ashita Tolwani, MD, MSc, a professor of medicine and the Edwin A. Rutsky Endowed Chair at the University of Alabama at Birmingham, said in the presentation. “It makes sense that fluid overload seems to have negative consequences. How about looking at fluid overload and acute kidney injury?”

Tolwani referenced a retrospective study of 210 ICU patients with stage 1 AKI in which increased fluid administration after early AKI correlated with less renal recovery. Moreover, increased fluid gain among patients with stage 1 AKI independently correlated with an increased risk of progression to stage 3 AKI, Tolwani said. Additionally, the study revealed fluid intake, rather than a reduction in urine output, independently correlated with progression to stage 3 AKI.

Another study Tolwani mentioned was a prospective, multicenter, observational study that explored fluid balance in 296 critically ill patients with AKI requiring renal replacement therapy. Results revealed patients with fluid overload, defined as greater than 10% of body weight, at renal replacement therapy initiation showed an increased risk for 90-day mortality.

A possible solution to fluid overload can be fluid removal, according to Tolwani. A cohort study that evaluated the association between changes in cumulative fluid balance and mortality revealed net fluid removal was independently associated with a lower mortality rate. Also, there was no independent association between fluid balance at initiation of continuous renal replacement therapy and outcome after correction for severity of illness and need for vasopressor support.

Overall, several studies suggest fluid overload greater than 10% correlates with worsening organ dysfunction, including AKI, and mortality, Tolwani said. Strategies for preventing and managing fluid overload include conservative fluid management, diuretic use and mechanical fluid removal. Currently, the optimal timing and best method of removing fluid and reversing fluid overload during renal replacement therapy are unknown, Tolwani said.

“I think that initiation methods and therapy should be done for fluid overload,” Tolwani said in the presentation. She added, “We just need further randomized control trials to determine how conservative fluid management strategies, including timing initiation in renal replacement therapy for volume removal in critically ill patients with AKI, will affect the outcomes.”