Abstract: FR-PO124
Volume Control Strategy and Patient and Kidney Survival in Sepsis-Associated AKI Receiving Continuous Kidney Replacement Therapy: A Randomized Controlled Trial
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Ahn, Hyojin, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Seo, Jun Hye, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Park, Cheol Ho, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Nam, Boyoung, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Ryu, Jaejin, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Kim, Gyu Ri, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Kim, Hyung Woo, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Park, Jung Tak, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Han, Seung Hyeok, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Kang, Shin-Wook, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
- Yoo, Tae-Hyun, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea (the Republic of)
Background
Volume overload in patients with sepsis-associated acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT) is associated with an increased risk of mortality. However, the optimal strategy for volume control and the clinical implication of achieved volume control in these patients is uncertain.
Methods
We randomly assigned patients with sepsis-associated AKI receiving CKRT accompanying volume overload with either conventional volume control strategy or bioelectrical impedance analysis (BIA)-guided volume control strategy for 3 days. The outcomes of interest were patient survival at 28 and 90 days. A post-hoc analysis was performed to compare patient survival according to achieved volume accumulation rate ([cumulative fluid balance during 3 days×100]/fluid overload) using multivariate Cox regression model.
Results
Of the 73 patients, 39 were randomly assigned to conventional volume control strategy, and 34 to BIA-guided volume control strategy. At 28 days after randomization, 20 (51.3%) deaths had occurred in the conventional volume control group and 19 (55.9%) deaths in the BIA-guided volume control group (P=0.69). There were no differences in 28-day mortality (HR, 1.19; 95% CI, 0.63–2.23) or 90-day mortality (HR, 0.99; 95% CI 0.57–1.75) between conventional volume control group and BIA-guided volume control group.
In the secondary analysis, achieved volume accumulation rate was significantly associated with patient survival. Compared with the achieved volume accumulation rate of ≤-50%, the HRs (95% CIs) for the risk of 28-day mortality were 0.90 (0.16-5.02), 0.21 (0.03-1.61), and 8.08 (1.18-55.50) in that of -50–0%, 1–50%, and >50%, respectively. In addition, the HRs (95% CIs) for the risk of 90-day mortality were 1.21 (0.29-5.01), 0.55 (0.12-2.48), and 7.18 (1.58-32.51) in that of -50–0%, 1–50%, and >50%, respectively.
Conclusion
BIA-guided volume control in patients receiving CKRT due to sepsis-associated AKI with volume overload did not improve patient outcomes. In the secondary analysis, achieved volume accumulation rate was associated with patient survival.