Critical Care

, 18:P388 | Cite as

Fluid accumulation post cardiac surgery and risk for renal replacement therapy

  • EM Moore
  • A Tobin
  • D Reid
  • J Santamaria
  • R Bellomo
Open Access
Poster presentation
  • 150 Downloads

Keywords

Renal Replacement Therapy Acute Kidney Injury Continuous Renal Replacement Therapy Fluid Accumulation Chest Drain 

Introduction

We assessed the impact of fluid accumulation on the development of acute kidney injury (AKI) and need for continuous renal replacement therapy in cardiac surgical patients. Fluid accumulation has been associated with negative outcomes including development of AKI in critically ill patients [1, 2, 3]. As cardiac surgical patients commonly receive large volumes of i.v. fluid within 24 hours of surgery, they could be at risk of the harmful effects of fluid accumulation.

Methods

We performed a retrospective analysis of prospectively collected data on all patients admitted after cardiac surgery to St Vincent's Hospital ICU, Melbourne, Australia from 1 July 2004 to 30 June 2012 (n = 3,207). The fluid accumulation percentage (total urine and chest drain losses subtracted from total i.v. intake (l) /weight (kg) × 100) was calculated for 18 hours post surgery as most patients were in the ICU for this period. Acute Kidney Injury Network (AKIN) creatinine criteria were used to classify AKI using creatinine adjusted for fluid balance.

Results

Renal replacement therapy was performed on 136 patients in this group (4.2%). The fluid accumulation percentage was associated with an 8% increase in odds for AKI (OR (Cl), 1.08 (1.04 to 1.12)), and a 13% increase in odds for requiring renal replacement therapy (1.13 (1.05 to 1.21)) for each percent increase in fluid accumulation (l/kg%) after cardiac surgery, after adjusting for variables including APACHE score, cardiac failure, type of surgery, and inotrope use in multivariate analysis.

Conclusion

In this relatively homogeneous patient group undergoing cardiac surgery, postoperative percent fluid accumulation at 18 hours was associated with AKI and need for renal replacement therapy. Whether there is residual confounding due to indication for fluid use or unmeasured risk factors requires further investigation in controlled trials.

References

  1. 1.
    Bouchard J, et al.: Kidney Int. 2009, 76: 422-427. 10.1038/ki.2009.159CrossRefPubMedGoogle Scholar
  2. 2.
    Payen D, et al.: Crit Care (London). 2008, 12: R74. 10.1186/cc6916CrossRefGoogle Scholar
  3. 3.
    Grams ME, et al.: Clin J Am Soc Nephrol. 2011, 6: 966-973. 10.2215/CJN.08781010PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Moore et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • EM Moore
    • 1
  • A Tobin
    • 2
  • D Reid
    • 2
  • J Santamaria
    • 2
  • R Bellomo
    • 1
  1. 1.Monash UniversityMelbourneAustralia
  2. 2.St Vincent's HospitalMelbourneAustralia

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