title: Fluid overload and survival in critically ill patients with acute kidney injury receiving continuous renal replacement therapy.
abstract: BACKGROUND
  Fluid overload is known to be associated with increased mortality in patients with acute kidney injury (AKI) who are critically ill. In this study, we intended to uncover whether the adverse effect of fluid overload on survival could be applied to all of the patients with AKI who received continuous renal replacement therapy (CRRT).
  
  
  METHODS
  We analyzed 341 patients with AKI who received CRRT in our intensive care units. The presence of fluid overload was defined as a minimum 10% increase in body weight from the baseline. Demographics, comorbid diseases, clinical data, severity of illness [the sequential organ failure assessment (SOFA) score, number of vasopressors, diagnosis of sepsis, use of ventilator] upon ICU admission, fluid overload status, and time elapsed from AKI diagnosis until CRRT initiation were reviewed from the medical charts.
  
  
  RESULTS
  Patients with total fluid overload from 3 days before CRRT initiation to ICU discharge had a significantly lower survival rate after ICU admission, as compared to patients with no fluid overload (P < 0.001). Among patients with sepsis (P < 0.001) or with high SOFA scores (P < 0.001), there was a significant difference in survival of the patients with and without fluid overload. In patients without sepsis or with low SOFA score, there was no significant difference in survival of patients irrespective of fluid overload.
  
  
  CONCLUSIONS
  Our study demonstrates that the adverse effect of fluid overload on survival is more evident in patients with sepsis or with more severe illness, and that it might not apply to patients without sepsis or with less severe illness.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Il Young
authors.initials: IY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Joo Hui
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors.forename: Soo Bong
authors.initials: SB
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Harin
authors.initials: H
authors.lastname: Rhee
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Seong
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Ihm Soo
authors.initials: IS
authors.lastname: Kwak
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.|Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Sang Heon
authors.identifier: http://orcid.org/0000-0002-8218-6974
authors.initials: SH
authors.lastname: Song
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000368:Aged; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate