title: An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy trial.
abstract: OBJECTIVE
  To examine associations between mean daily fluid balance during intensive care unit study enrollment and clinical outcomes in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) replacement therapy study.
  
  
  METHODS
  Statistical analysis of data from multicenter, randomized, controlled trials.
  
  
  METHODS
  Thirty-five intensive care units in Australia and New Zealand.
  
  
  METHODS
  Cohort of 1453 patients enrolled in the RENAL study.
  
  
  METHODS
  We analyzed the association between daily fluid balance on clinical outcomes using multivariable logistic regression, Cox proportional hazards, time-dependent analysis, and repeated measure analysis models.
  
  
  RESULTS
  During intensive care unit stay, mean daily fluid balance among survivors was -234 mL/day compared with +560 mL/day among nonsurvivors (p < .0001). Mean cumulative fluid balance over the same period was -1941 vs. +1755 mL (p = .0003). A negative mean daily fluid balance during study treatment was independently associated with a decreased risk of death at 90 days (odds ratio 0.318; 95% confidence interval 0.24-0.43; p < .000.1) and with increased survival time (p < .0001). In addition, a negative mean daily fluid balance was associated with significantly increased renal replacement-free days (p = .0017), intensive care unit-free days (p < .0001), and hospital-free days (p = .01). These findings were unaltered after the application of different statistical models.
  
  
  CONCLUSIONS
  In the RENAL study, a negative mean daily fluid balance was consistently associated with improved clinical outcomes. Fluid balance may be a target for specific manipulation in future interventional trials of critically ill patients receiving renal replacement therapy.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.forename: Louise
authors.initials: L
authors.lastname: Cole
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Martin
authors.initials: M
authors.lastname: Gallagher
authors.forename: Joanne
authors.initials: J
authors.lastname: Lee
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.forename: Colin
authors.initials: C
authors.lastname: McArthur
authors.forename: Shay
authors.initials: S
authors.lastname: McGuiness
authors.forename: Robyn
authors.initials: R
authors.lastname: Norton
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: Carlos
authors.initials: C
authors.lastname: Scheinkestel
authors.forename: Steve
authors.initials: S
authors.lastname: Su
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000502:physiology*