Fluid Overload and Precision Net Ultrafiltration in Critically Ill Patients

Cardiorenal medicine

article

Murugan, Raghavan¹  Kazory, Amir³  Sgarabotto, Luca⁴  Ronco, Claudio⁵ 

[1] The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine;The Clinical Research, Investigation, and Systems Modeling of Acute Illness ,(CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine;Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida;Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova;Department of Medicine, University of Padova;International Renal Research Institute of Vicenza and Department of Clinical Nephrology, San Bortolo Hospital

关键词: Net ultrafiltration;    Kidney replacement therapy;    Fluid overload;    Mortality;   

DOI  :  10.1159/000527390

学科分类：心脏病和心血管学

来源: S Karger AG

【 摘 要 】

Background: Fluid overload is present in two-thirds of critically ill patients with acute kidney injury and is associated with morbidity, mortality, and increased healthcare resource utilization. Kidney replacement therapy (KRT) is frequently used for net fluid removal (i.e., net ultrafiltration [UFNET]) in patients with severe oliguric acute kidney injury. However, ultrafiltration has considerable risks associated with it, and there is a need for newer technology to perform ultrafiltration safely and to improve outcomes. Summary: Caring for a critically ill patient with oliguric acute kidney injury and fluid overload is one of the most challenging problems. Although diuretics are the first-line treatment for management of fluid overload, diuretic resistance is common. Various clinical practice guidelines support fluid removal using ultrafiltration during KRT. Emerging evidence from observational studies in critically ill patients suggests that both slow and fast rates of net fluid removal during continuous kidney replacement therapy are associated with increased mortality compared with moderate UFNET rates. In addition, fast UFNET rates are associated with an increased risk of cardiac arrhythmias. Randomized trials are required to examine whether moderate UFNET rates are associated with a reduced risk of hemodynamic instability, organ injury, and improved outcomes in critically ill patients. There is a need for newer technology for fluid removal in patients who do not meet traditional criteria for initiation of KRT. Emerging newer and miniaturized ultrafiltration devices may address an unmet clinical need. Key Messages: Among critically ill patients with acute kidney injury and fluid overload requiring continuous kidney replacement therapy, use of higher and slower UFNET rates compared with moderate UFNET rates might be associated with poor outcomes. Newer minimally invasive technologies may allow for safe and efficient UFNET in patients with acute kidney injury who do not meet criteria for initiation of KRT.

【 授权许可】

CC BY