Observational studyCritical care (London, England)2013
Fluid balance and urine volume are independent predictors of mortality in acute kidney injury.
Observational study in Critical care (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 93 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
93 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Intermittent furosemide administration in patients with or at risk for acute kidney injury: Meta-analysis of randomized trials.PloS one · 2018Pooled it
- Targeting urine output and 30-day mortality in goal-directed therapy: a systematic review with meta-analysis and meta-regression.BMC anesthesiology · 2017Pooled it
- Non-interventional follow-up versus fluid bolus in RESPONSE to oliguria in hemodynamically stable critically ill patients: a randomized controlled pilot trial.Critical care (London, England) · 2022Trial
- A randomized trial of albumin infusion to prevent intradialytic hypotension in hospitalized hypoalbuminemic patients.Critical care (London, England) · 2021Trial
- Hypertonic saline for fluid resuscitation in ICU patients post-cardiac surgery (HERACLES): a double-blind randomized controlled clinical trial.Intensive care medicine · 2020Trial
- Effect of restrictive fluid balance in critically ill patients with acute kidney injury: a target trial emulation.Critical care (London, England) · 2026Article
- Relationship between urine output and 28-day mortality in patients with acute kidney injury receiving continuous renal replacement therapy.BMC nephrology · 2026Article
- Lactate-to-albumin ratio improves prediction of perioperative mortality in lung transplant patients.Frontiers in medicine · 2026Article
- Pre-CRRT furosemide and mortality in sepsis-associated AKI: A retrospective cohort study.PloS one · 2026Article
- Extreme Fluid Accumulation Syndrome or Compartmental Balance Disorder? A Sepsis-Associated Acute Kidney Injury Case Report and Literature Review.Journal of clinical medicine · 2025Article
- Management of non-Cardiac Organ Failure in cardiogenic shock.American heart journal plus : cardiology research and practice · 2025Article
- Clinical Assessment of Fluid Status in Adults With Acute Kidney Injury: A Scoping Review.Journal of renal care · 2025Article
- Persistent severe acute kidney injury is a major modifiable determinant of outcome during critical illness.Intensive care medicine · 2025Article
- Association between the use of loop diuretics and prognosis in critically ill patients with acute kidney injury: a retrospective propensity score-matched cohort study.International urology and nephrology · 2025Article
- Understanding fluid dynamics and renal perfusion in acute kidney injury management.Journal of clinical monitoring and computing · 2025Review
- Impact of an Educational Intervention on Nurses' Knowledge and Practice in Early Detection of Acute Kidney Injury at Mbarara Regional Referral Hospital, Western Uganda.Advances in medical education and practice · 2025Article
- Linear Correlation Between Mean Arterial Pressure and Urine Output in Critically Ill Patients.Critical care explorations · 2024Observational
- Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review.Annals of intensive care · 2024Review
- Article
- Explainable machine learning model for predicting furosemide responsiveness in patients with oliguric acute kidney injury.Renal failure · 2023Article
33 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn ICUs, both fluid overload and oliguria are common complications associated with increased mortality among critically ill patients, particularly in acute kidney injury (AKI). Although fluid overload is an expected complication of oliguria, it remains unclear whether their effects on mortality are independent of each other. The aim of this study is to evaluate the impact of both fluid balance and urine volume on outcomes and determine whether they behave as independent predictors of mortality in adult ICU patients with AKI.
methodsWe performed a secondary analysis of data from a multicenter, prospective cohort study in 10 Italian ICUs. AKI was defined by renal sequential organ failure assessment (SOFA) score (creatinine >3.5 mg/dL or urine output (UO) <500 mL/d). Oliguria was defined as a UO <500 mL/d. Mean fluid balance (MFB) and mean urine volume (MUV) were calculated as the arithmetic mean of all daily values. Use of diuretics was noted daily. To assess the impact of MFB and MUV on mortality of AKI patients, multivariate analysis was performed by Cox regression.
resultsOf the 601 included patients, 132 had AKI during their ICU stay and the mortality in this group was 50%. Non-surviving AKI patients had higher MFB (1.31 ± 1.24 versus 0.17 ± 0.72 L/day; P <0.001) and lower MUV (1.28 ± 0.90 versus 2.35 ± 0.98 L/day; P <0.001) as compared to survivors. In the multivariate analysis, MFB (adjusted hazard ratio (HR) 1.67 per L/day, 95%CI 1.33 to 2.09; <0.001) and MUV (adjusted HR 0.47 per L/day, 95%CI 0.33 to 0.67; <0.001) remained independent risk factors for 28-day mortality after adjustment for age, gender, diabetes, hypertension, diuretic use, non-renal SOFA and sepsis. Diuretic use was associated with better survival in this population (adjusted HR 0.25, 95%CI 0.12 to 0.52; <0.001).
conclusionsIn this multicenter ICU study, a higher fluid balance and a lower urine volume were both important factors associated with 28-day mortality of AKI patients.
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