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

Published on Jul 1, 2011in Intensive Care Medicine18.967
· DOI :10.1007/s00134-011-2231-3
David T. Selewski22
Estimated H-index: 22
(UM: University of Michigan),
Timothy T. Cornell20
Estimated H-index: 20
(UM: University of Michigan)
+ 7 AuthorsMichael Heung23
Estimated H-index: 23
(UM: University of Michigan)
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.
  • References (40)
  • Citations (87)
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References40
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#1M. Antonelli (UCSC: Catholic University of the Sacred Heart)H-Index: 97
#2Marc J. M. Bonten (UU: Utrecht University)H-Index: 73
Last. Haibo Zhang (U of T: University of Toronto)H-Index: 7
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Year in review in Intensive Care Medicine 2011 : I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals
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#1Claudio RoncoH-Index: 84
#2Pier Paolo Giomarelli (UNISI: University of Siena)H-Index: 19
Ultrafiltration has been used in patients with decompensated HF and volume overload refractory to diuretics. Criteria for the initiation of renal replacement therapy (RRT) in the ICU are oliguria, anuria, urea, creatinine, Na and K blood concentrations, pulmonary edema unresponsive to diuretics, uncompensated metabolic acidosis, temperature >40°C, uremic complication, and overdose with a dialyzable toxin. Moreover, the treatment of acute renal failure requires a different style and philosophy fr...
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Objective To assess the outcome of pediatric patients supported by concomitant extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT).
70 CitationsSource
#1James SchneiderH-Index: 8
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#1Jorge Cerdá (Albany Medical College)H-Index: 21
#2Geoffrey Sheinfeld (University of Maryland Medical Center)H-Index: 1
Last. Claudio RoncoH-Index: 84
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Fluid overload may occur in critically ill patients as a result of aggressive resuscitation therapies. In such circumstances, persistent fluid overload must be avoided since it does not benefit the patient while it may be harmful. In the septic patient, early volume expansion seems to be beneficial. Beyond that threshold, when organ failure develops, fluid overload has been shown to be associated with worse outcomes in multiple disparate studies. One well-designed randomized controlled trial sho...
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#1John R. ProwleH-Index: 27
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Intravenous fluids are widely administered to patients who have, or are at risk of, acute kidney injury (AKI). However, deleterious consequences of overzealous fluid therapy are increasingly being recognized. Salt and water overload can predispose to organ dysfunction, impaired wound healing and nosocomial infection, particularly in patients with AKI, in whom fluid challenges are frequent and excretion is impaired. In this Review article, we discuss how interstitial edema can further delay renal...
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#2Lung (Vandy: Vanderbilt University)H-Index: 2
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#1Leslie W. Hayes (UAB: University of Alabama at Birmingham)H-Index: 5
#2Robert A. Oster (UAB: University of Alabama at Birmingham)H-Index: 27
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#1Stuart L. Goldstein (BCM: Baylor College of Medicine)H-Index: 54
The disease spectrum leading to pediatric renal replacement therapy (RRT) provision has broadened over the last decade. In the 1980’s, intrinsic renal disease and burns comprised the most common pediatric acute kidney injury (AKI) etiologies. More recent data demonstrate that pediatric AKI most often results from complications of other systemic diseases resulting from the advancements in congenital heart surgery, neonatal care, and bone marrow and solid organ transplantation. In addition, RRT mo...
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#1Arwa Nada (UTHSC: University of Tennessee Health Science Center)H-Index: 2
#2David J. Askenazi (UAB: University of Alabama at Birmingham)H-Index: 30
Last. Russell Griffin (UAB: University of Alabama at Birmingham)H-Index: 23
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Background Studies in adults showed a relationship between low hemoglobin (Hb) and acute kidney injury (AKI). We performed this study to evaluate this association in newborns. Methods We evaluated 1891 newborns from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database. We evaluated the associations for the entire cohort and 3 gestational age (GA) groups: Results Minimum Hb in the first postnatal week was significantly lower in neonates with AKI after the first postnatal wee...
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BACKGROUND: The management of fluid overload after congenital heart surgery has been limited to diuretics, fluid restriction, and dialysis. This study was conducted to determine the association between peritoneal dialysis and important clinical outcomes in children undergoing congenital heart surgery. METHODS: A retrospective review was conducted to identify patients under 18 years of age who underwent congenital heart surgery. The data were obtained over a 16-year period (1997-2012) from the Ki...
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#1Sonali Basu (GW: George Washington University)
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#1David T. Selewski (MUSC: Medical University of South Carolina)H-Index: 22
#1Selewski Dt (MUSC: Medical University of South Carolina)
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We evaluated the epidemiology of fluid balance (FB) over the first postnatal week and its impact on outcomes in a multi-center cohort of premature neonates from the AWAKEN study. Retrospective analysis of infants <36 weeks’ gestational age from the AWAKEN study (N = 1007). FB was defined by percentage of change from birth weight. Outcome: Mechanical ventilation (MV) at postnatal day 7. One hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: −2.9, 2) and ...
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#1Stephen M. Gorga (UM: University of Michigan)H-Index: 1
#2Rashmi D. Sahay (Cincinnati Children's Hospital Medical Center)H-Index: 3
Last. David T. Selewski (MUSC: Medical University of South Carolina)H-Index: 22
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The aim of this study was to characterize continuous renal replacement therapy (CRRT) utilization on extracorporeal membrane oxygenation (ECMO) and to determine the association of both fluid overload (FO) at CRRT initiation and fluid removal during CRRT with mortality in a large multicenter cohort. Retrospective chart review of all children < 18 years of age concurrently treated with ECMO and CRRT from January 1, 2007, to December 31, 2011, at six tertiary care children’s hospital. Children trea...
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The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines are used to diagnose acute kidney injury (AKI) in children, similar to in adults. However, while there are age-specific reference levels of serum creatinine used as a standard for diagnosing AKI, the criteria have yet to be defined for infants younger than 3 months of age. Preterm and low-birth-weight children have high risks of developing AKI, and those who do indeed present with AKI have a worse survival than th...
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#1Shina Menon (UW: University of Washington)H-Index: 1
#2John Broderick (University of Cincinnati Academic Health Center)H-Index: 1
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Background and objectives Provision of kidney replacement therapy (KRT) to manage kidney injury and volume overload in critically ill neonates and small children is technically challenging. The use of machines designed for adult-sized patients, necessitates large catheters, a high extracorporeal volume relative to patient size, and need for blood priming. The Aquadex FlexFlow System (CHF Solutions Inc., Eden Prairie, MN) is an ultrafiltration device designed for fluid removal in adults with diur...
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