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Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy

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Abstract

Purpose

In pediatric intensive care unit (PICU) patients, fluid overload (FO) at initiation of continuous renal replacement therapy (CRRT) has been reported to be an independent risk factor for mortality. Previous studies have calculated FO based on daily fluid balance during ICU admission, which is labor intensive and error prone. We hypothesized that a weight-based definition of FO at CRRT initiation would correlate with the fluid balance method and prove predictive of outcome.

Methods

This is a retrospective single-center review of PICU patients requiring CRRT from July 2006 through February 2010 (n = 113). We compared the degree of FO at CRRT initiation using the standard fluid balance method versus methods based on patient weight changes assessed by both univariate and multivariate analyses.

Results

The degree of fluid overload at CRRT initiation was significantly greater in nonsurvivors, irrespective of which method was used. The univariate odds ratio for PICU mortality per 1% increase in FO was 1.056 [95% confidence interval (CI) 1.025, 1.087] by the fluid balance method, 1.044 (95% CI 1.019, 1.069) by the weight-based method using PICU admission weight, and 1.045 (95% CI 1.022, 1.07) by the weight-based method using hospital admission weight. On multivariate analyses, all three methods approached significance in predicting PICU survival.

Conclusions

Our findings suggest that weight-based definitions of FO are useful in defining FO at CRRT initiation and are associated with increased mortality in a broad PICU patient population. This study provides evidence for a more practical weight-based definition of FO that can be used at the bedside.

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Acknowledgments

David T. Selewski is supported by the Cellular and Molecular Biology in Pediatrics Training Program grant (T-32 HD007513-13). Timothy T. Cornell is supported by the Pediatric Critical Care Scientist Development Program (K12HD047349) and an individual Career Development Award (K08HD062142). Neal B. Blatt is supported by a Child Health Research Career Development Award (National Institutes of Health, K12 HD 028820 (T32 DK 065517).

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    David T. Selewski, Rebecca M. Lombel, Neal B. Blatt, Theresa Mottes & David B. Kershaw

  2. Division of Critical Care, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    Timothy T. Cornell, Yong Y. Han & Thomas P. Shanley

  3. Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Mallika Kommareddi & Michael Heung

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  1. David T. Selewski
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  2. Timothy T. Cornell
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Correspondence to David T. Selewski.

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Selewski, D.T., Cornell, T.T., Lombel, R.M. et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 37, 1166–1173 (2011). https://doi.org/10.1007/s00134-011-2231-3

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  • DOI: https://doi.org/10.1007/s00134-011-2231-3

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