Rapid fluid elimination associated with increased risk of death in patients with ARI

According to a study published by researchers at the University of Pittsburgh School of Medicine, the rate and speed of elimination of dialysis fluids in patients with ARI can affect the risk of mortality.

"We want to eliminate excess fluid from our patients before it causes damage, but by removing it, we actually cause a controlled loss of fluid that can sometimes cause heart stress and lead to dangerous hypotension »author Raghavan Murugan, MD, MS, Associate Professor in the Department of Critical Care Medicine and Physician at UPMC (University of Pittsburgh School of Medicine), said in a press release. "So, the question: what is the speed to eliminate the fluid? – It has been many years that we ask the world of critical care, but there was no good answer. "

Previous studies of outpatient dialysis patients who were not seriously ill showed that rapid elimination of fluid was 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, to determine whether this discovery extends to seriously ill patients.

Their team reviewed data from 1,434 patients previously collected by Bellomo in the randomized evaluation study of renal substitution therapy between normal and increased level, which ran from December 30, 2005 to November 28, 2008 in 35 intensive care units in Australia. and New Zealand. The primary endpoint was 90-day survival of participation in the study.

The research team found that for every 0.5 milliliter increase in fluid per kilogram of patient weight per hour (0.5 mL / kg / hr), the patient's risk of death increased. This translates into an increased risk of death from 51% to 66% over the next 3 months in critically ill patients for whom excess fluid is eliminated at a rate greater than 1.75 mL / kg / hr compared to patients for whom the excess fluid is eliminated flow rate less than 1.01 mL / kg / h.

Murugan noted that his badysis showed an badociation and not a causal link; Until a clinical trial is carried out to specifically test the effects of the faster elimination of fluid, it can not be said with certainty that removing the liquid slowly is preferable for the patient and, in some cases, such as impending heart failure, Murugan said in a faster elimination. liquid 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, but in a patient for whom I do not find the immediate need to take the fluid quickly, I will withdraw it at a slower rate until I get the final results and advice from a clinical trial, "said Murugan, also a member of the Center for Clinical Research, Investigation. and modeling of Acute Disease Systems and the UPMC Nephrology Critical Care Center.

Reference:

www.upmc.com/media/news/060719-murugan-filtration-rate

Disclosures: Murugan reports receiving grants and personal fees from La Jolla Inc., Bioporto Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Beckman Coulter and AM Pharma Inc. Please refer to the study for information other authors.