title: Fluid overload and outcomes in neonates receiving continuous renal replacement therapy.
abstract: Continuous renal replacement therapy (CRRT) has emerged as the modality of choice for the management of high-risk neonates with acute kidney injury (AKI), inborn errors of metabolism and multi-organ dysfunction. The aim of this study was to evaluate fluid overload (FO) and investigate the factors associated with outcomes in neonates undergoing CRRT.
  
  
  
  We retrospectively reviewed the medical records of 34 neonates with AKI who were admitted to the neonatal intensive care unit (NICU) of Samsung Medical Center, Seoul, Republic of Korea between January 2007 and December 2014 where they underwent at least 24 h of CRRT.
  
  
  
  The survival rates of patients with an FO of ≥30 % at the time of CRRT initiation were lower than those of patients with an FO of <30 % at the same time-point. Univariate Cox regression analysis revealed that a higher percentage FO at CRRT initiation and decreased urine output at the end of CRRT were associated with mortality, and multivariate Cox regression analysis indicated that mortality was associated with decreased urine output at the end of CRRT. Univariate linear regression analysis revealed that the length of hospital stay was associated with higher levels of serum creatinine at CRRT initiation, longer stay in the NICU prior to initiation of CRRT, longer duration of CRRT and lower body weight at the time of NICU admission.
  
  
  
  Neonates with a higher percentage FO and higher levels of serum creatinine at CRRT initiation showed poor outcomes. Early initiation of CRRT before the development of severe FO or azotemia might improve the outcomes of neonates requiring CRRT.
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
authors.forename: Sang Taek
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea. choheeyeon@gmail.com.
authors.forename: Heeyeon
authors.identifier: 0000-0003-3137-6054
authors.initials: H
authors.lastname: Cho
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality / Q000628:therapy*; D053099:Azotemia / Q000097:blood / Q000401:mortality; D001826:Body Fluids; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood / Q000378:metabolism; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007677:Kidney Function Tests; D007902:Length of Stay; D008297:Male; D008661:Metabolism, Inborn Errors / Q000097:blood / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056910:Republic of Korea; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000401:mortality* / Q000503:physiopathology
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Continuous renal replacement therapy; Fluid overload; Neonate