An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial

The RENAL Replacement Therapy Study Investigators

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167 Citations (Scopus)

Abstract

Objective: To examine associations between mean daily fluid balance during intensive care unit study enrollment and clinical outcomes in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) replacement therapy study. Design: Statistical analysis of data from multicenter, randomized, controlled trials. Setting: Thirty-five intensive care units in Australia and New Zealand. Patients: Cohort of 1453 patients enrolled in the RENAL study. Interventions: We analyzed the association between daily fluid balance on clinical outcomes using multivariable logistic regression, Cox proportional hazards, time-dependent analysis, and repeated measure analysis models. Measurements and Main Results: During intensive care unit stay, mean daily fluid balance among survivors was-234 mL/day compared with +560 mL/day among nonsurvivors (p < .0001). Mean cumulative fluid balance over the same period was-1941 vs. +1755 mL (p = .0003). A negative mean daily fluid balance during study treatment was independently associated with a decreased risk of death at 90 days (odds ratio 0.318; 95% confidence interval 0.24-0.43; p < .000.1) and with increased survival time (p < .0001). In addition, a negative mean daily fluid balance was associated with significantly increased renal replacement-free days (p = .0017), intensive care unit-free days (p < .0001), and hospital-free days (p = .01). These findings were unaltered after the application of different statistical models. Conclusions: In the RENAL study, a negative mean daily fluid balance was consistently associated with improved clinical outcomes. Fluid balance may be a target for specific manipulation in future interventional trials of critically ill patients receiving renal replacement therapy.

Original languageEnglish
Pages (from-to)1753-1760
Number of pages8
JournalCritical Care Medicine
Volume40
Issue number6
DOIs
Publication statusPublished - 1 Jan 2012
Externally publishedYes

Keywords

  • acute kidney injury
  • continuous renal replacement therapy
  • hemodialysis
  • hemofiltration
  • intensive care
  • kidney

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