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The faster the fluid is removed by continuous dialysis in patients whose kidneys are in kidney failure, the higher the risk of death in the coming months, according to a study published today in JAMA Network open now by researchers from the University of Pittsburgh School of Medicine.
Nearly two-thirds of critically ill patients with acute kidney injury have fluid buildup in their bodies, which can put pressure on their lungs and injure other organs. To relieve this pressure, clinicians routinely remove excess blood fluid during dialysis in an intensive care unit. But there is no indication on how fast this fluid should be eliminated.
We want to eliminate excess fluid from our patients before it causes damage, but by removing it, we actually cause fluid loss that can sometimes cause stress to the heart and lead to dangerous hypotension . So the question – how fast do you remove the fluid? – was asked in the critical care community for many years, but there was no good answer. "
Lead Author Raghavan Murugan, M.D., M.S., Associate Professor in Pitt's Department of Critical Care Medicine and UPMC Physician
Previous studies on ambulatory patients who are not seriously ill have revealed that this systematic procedure for the disposal of wastes, toxins, salt and extra water in the blood of people whose kidneys had failed is badociated with an increased risk of death.
Murugan is badociated with lead author Rinaldo Bellomo, MD, Ph.D., professor of intensive care medicine at the University of Melbourne, Australia, to determine whether this discovery is occurring. extends to seriously ill patients. Their team reviewed data from 1,434 patients that Bellomo had previously collected in the randomized evaluation study of renal substitution therapy between normal and increased levels, conducted from 30 December 2005 to 28 November 2008 in 35 intensive care in Australia and New Brunswick. Zealand.
The research team found that for every 0.5 milliliter increase in fluid per kilogram of patient weight per hour (0.5 mL / kg / h), their risk of death increased. This translates into an increased risk of death from 51% to 66% over the next three months for critically ill patients for whom excess fluid is eliminated at a rate greater than 1.75 mL / kg / hr. , compared to patients for whom excess fluid is eliminated a flow rate less than 1.01 mL / kg / h.
For an older American, it's a difference to remove a gallon of fluid in about a day compared to just under two days.
Murugan is quick to point out that his badysis shows the badociation, not the causality; Until a clinical trial is performed to specifically test the effects of removing the fluid faster than slower, it can not be said with certainty that removing the fluid slowly is preferable for the patient. And, in some cases, such as impending heart failure, Murugan says that a faster elimination of fluid could be justified to prevent sudden death.
"You have to balance the pros and cons and decide how quickly to remove the fluid depending on the clinical condition of your patient," said Murugan, also a member of the Center for Clinical Research, Investigation and Research. Modeling systems of acute Pitt disease. Nephrology Critical Care Center. "But in a patient for whom I do not find the immediate need to draw fluid quickly, I will take it at a slower pace until the final results and tips are obtained." clinical test."
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