Your browser doesn't support javascript.
loading
Mediators of the Impact of Hourly Net Ultrafiltration Rate on Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy.
Naorungroj, Thummaporn; Neto, Ary Serpa; Zwakman-Hessels, Lara; Fumitaka, Yanase; Eastwood, Glenn; Murugan, Raghavan; Kellum, John A; Bellomo, Rinaldo.
Afiliação
  • Naorungroj T; Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Neto AS; Department of Intensive Care, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
  • Zwakman-Hessels L; Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
  • Fumitaka Y; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Eastwood G; Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.
  • Murugan R; ANZICS-Research Centre, Monash University Division and School of Public Health and Preventive Medicine, Melbourne, VIC, Australia.
  • Kellum JA; Data Analytics Research and Evaluation (DARE) Centre, Department of Clinical Informatics Austin Hospital and University of Melbourne, Melbourne, VIC, Australia.
  • Bellomo R; Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Crit Care Med ; 48(10): e934-e942, 2020 10.
Article em En | MEDLINE | ID: mdl-32885938
ABSTRACT

OBJECTIVES:

During continuous renal replacement therapy, a high net ultrafiltration rate has been associated with increased mortality. However, it is unknown what might mediate its putative effect on mortality. In this study, we investigated whether the relationship between early (first 48 hr) net ultrafiltration and mortality is mediated by fluid balance, hemodynamic instability, or low potassium or phosphate blood levels using mediation analysis and the primary outcome was hospital mortality.

DESIGN:

Retrospective, observational study.

SETTING:

Mixed medical and surgical ICUs at Austin hospital, Melbourne, Australia. PATIENTS Critically ill patients treated with continuous renal replacement therapy within 14 days of ICU admission who survived greater than 48 hours.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

We studied 347 patients (median [interquartile range] age 64 yr [53-71 yr] and Acute Physiology and Chronic Health Evaluation III score 73 (54-90)]. After adjustment for confounders, compared with a net ultrafiltration less than 1.01 mL/kg/hr, a net ultrafiltration rate greater than 1.75 mL/kg/hr was associated with significantly greater mortality (adjusted odds ratio, 1.15; 95% CI, 1.03-1.29; p = 0.011). Adjusted univariable mediation analysis found no suggestion of a causal mediation pathway for this effect by blood pressure, vasopressor therapy, or potassium levels, but identified a possible mediation effect for fluid balance (average causal mediation effect, 0.95; 95% CI, 0.89-1.00; p = 0.060) and percentage of phosphate measurements with hypophosphatemia (average causal mediation effect, 0.96; 95% CI, 0.92-1.00; p = 0.055). However, on multiple mediator analyses, these two variables showed no significant effect. In contrast, a high net ultrafiltration rate had an average direct effect of 1.24 (95% CI, 1.11-1.40; p < 0.001).

CONCLUSIONS:

An early net ultrafiltration greater than 1.75 mL/kg/hr was independently associated with increased hospital mortality. Its putative effect on mortality was direct and not mediated by a causal pathway that included fluid balance, low blood pressure, vasopressor use, hypokalemia, or hypophosphatemia.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Estado Terminal / Terapia de Substituição Renal Contínua Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Med Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Austrália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Estado Terminal / Terapia de Substituição Renal Contínua Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Med Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Austrália