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An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial

Bellomo, R., Cass, Alan, Cole, L., Finfer, S., Gallagher, Martin, Lee, Joanne, Lo, Serigne, McArthur, C., McGuinness, S., Myburgh, J., Norton, R., Scheinkestel, C. and The RENAL Replacement Therapy Study Investigators (2012). An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial. Critical Care Medicine,40(6):1753-1760.

Document type: Journal Article

IRMA ID 84473293xPUB24
Title An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial
Author Bellomo, R.
Cass, Alan
Cole, L.
Finfer, S.
Gallagher, Martin
Lee, Joanne
Lo, Serigne
McArthur, C.
McGuinness, S.
Myburgh, J.
Norton, R.
Scheinkestel, C.
The RENAL Replacement Therapy Study Investigators
Journal Name Critical Care Medicine
Publication Date 2012
Volume Number 40
Issue Number 6
ISSN 0090-3493   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84861494538
Start Page 1753
End Page 1760
Total Pages 7
Place of Publication United States
Publisher Lippincott Williams & Wilkins
HERDC Category C1 - Journal Article (DIISR)
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.

Design: Statistical analysis of data from multicenter, randomized, controlled trials.

Setting: Thirty-five intensive care units in Australia and New Zealand.

Patients: Cohort of 1453 patients enrolled in the RENAL study.

Interventions: 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.

Measurements and Main 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.
DOI http://dx.doi.org/10.1097/CCM.0b013e318246b9c6   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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