ArticlePloS one2022
Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 14 citations in OpenAlex.
- Ultrafiltration in the critically ill patient: a framework for personalized care.Critical care (London, England) · 2026Review
- Comparison of a Kidney Intensive Care Unit Healthcare-Led Model versus a Traditional Haemodialysis Nurse-Led Model for Continuous Renal Replacement Therapy: A Retrospective Observational Study.Therapeutics and clinical risk management · 2026Article
- Trajectories of fluid management after the initiation of renal replacement therapy in critically ill patients: a secondary analysis of the STARRT-AKI trial.Critical care (London, England) · 2025Article
- Association of continuous renal replacement therapy downtime with fluid balance gap and clinical outcomes: a retrospective cohort analysis utilizing EHR and machine data.Journal of intensive care · 2024Article
- Achievement of fluid removal targets during intermittent renal replacement therapy in the intensive care unit.Clinical kidney journal · 2024Article
- Precision net ultrafiltration dosing in continuous kidney replacement therapy: a practical approach.Intensive care medicine experimental · 2023Article
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Authors and funding
11 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundFluid management during continuous renal replacement therapy (CRRT) requires accuracy in the prescription of desired patient fluid balance (FBGoal) and precision in the attainable patient fluid balance (FBAchieved). Herein, we examined the association of the gap between prescribed vs. achieved patient fluid balance during CRRT (%FBGap) with hospital mortality in critically ill patients.
methodsCohort study of critically ill adults with acute kidney injury (AKI) requiring CRRT and a prescription of negative fluid balance (mean patient fluid balance goal of negative ≥0.5 liters per day). Fluid management parameters included: 1) NUF (net ultrafiltration rate); 2) FBGoal; 3) FBAchieved; and 4) FBGap (% gap of fluid balance achieved vs. goal), all adjusted by patient's weight (kg) and duration of CRRT (hours).
resultsData from 653 patients (median of 102.2 patient-hours of CRRT) were analyzed. Mean (SD) age was 56.7 (14.6) years and 61.9% were male. Hospital mortality rate was 64%. Despite FBGoal was similar in patients who died vs. survived, survivors achieved greater negative fluid balance during CRRT than non-survivors: median FBAchieved -0.25 [-0.52 to -0.05] vs. 0.06 [-0.26 to 0.62] ml/kg/h, p<0.001. Median NUF was lower in patients who died vs. survived: 1.06 [0.63-1.47] vs. 1.22 [0.82-1.69] ml/kg/h, p<0.001, and median %FBGap was higher in patients who died (112.8%, 61.5 to 165.7) vs. survived (64.2%, 30.5 to 91.8), p<0.001. In multivariable models, higher %FBGap was independently associated with increased risk of hospital mortality: aOR (95% CI) 1.01 (1.01-1.02), p<0.001. NUF was not associated with hospital mortality when adjusted by %FBGap and other clinical parameters: aOR 0.96 (0.72-1.28), p = 0.771.
conclusionsHigher %FBGap was independently associated with an increased risk of hospital mortality in critically ill adults with AKI on CRRT in whom clinicians prescribed negative fluid balance via CRRT. %FBGap represents a novel quality indicator of CRRT delivery that could assist with operationalizing fluid management interventions during CRRT.
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