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Fluid overload and outcomes in neonates receiving continuous renal replacement therapy

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

The authors would like to acknowledge the help of Sin-Ho Jung and Kiyoun Kim (Biostatistics and Clinical Epidemiology Center, Samsung Medical Center) for their support with statistical analysis.

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Authors and Affiliations

  1. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea

    Sang Taek Lee & Heeyeon Cho

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  1. Sang Taek Lee
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  2. Heeyeon Cho
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Corresponding author

Correspondence to Heeyeon Cho.

Ethics declarations

All data were obtained in accordance with the ethical principles for medical research involving human subjects established in the Helsinki Declaration of 1975 and revised in 2000. The Institutional Review Board of Samsung Medical Center approved this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Cite this article

Lee, S.T., Cho, H. Fluid overload and outcomes in neonates receiving continuous renal replacement therapy. Pediatr Nephrol 31, 2145–2152 (2016). https://doi.org/10.1007/s00467-016-3363-z

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  • DOI: https://doi.org/10.1007/s00467-016-3363-z

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