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Fluid balance, biomarkers of renal function and mortality in critically ill patients with AKI diagnosed before, or within 24 h of intensive care unit admission: a prospective study

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Abstract

Background

To evaluate fluid balance, biomarkers of renal function and its relation to mortality in patients with acute kidney injury (AKI) diagnosed before, or within 24 h of intensive care unit admission.

Methods

A prospective cohort study considered 773 critically ill patients observed over six years. Pre-intensive care unit-onset AKI was defined as AKI diagnosed before, or within 24 h of intensive care unit admission. Body weight-adjusted fluid balance and fluid balance-adjusted biomarkers of renal function were measured daily for the first three days of intensive care unit admission. Primary outcome was mortality in the intensive care unit.

Results

Prevalence of pre-intensive care unit-onset AKI was 55.1%, of which 55.6% of cases were hospital-acquired and 44.4% were community-acquired. Fluid balance was higher in AKI patients than in non-AKI patients (p < 0.001) and had a negative correlation with urine output (p < 0.01). Positive fluid balance and biomarkers of renal function were independently related to mortality. Multivariate analysis identified the following AKI-related variables associated with increased mortality: (1) In AKI patients: type 1 cardiorenal syndrome (OR 2.00), intra-abdominal hypertension (OR 1.71), AKI stage 3 (OR 2.15) and increase in AKI stage (OR 4.99); 2) In patients with community-acquired AKI: type 1 cardiorenal syndrome (OR 5.16), AKI stage 2 (OR 2.72), AKI stage 3 (OR 4.95) and renal replacement therapy (OR 3.05); and 3) In patients with hospital-acquired AKI: intra-abdominal hypertension (OR 2.31) and increase in AKI stage (OR 4.51).

Conclusions

In patients with pre-intensive care unit-onset AKI, positive fluid balance is associated with worse renal outcomes. Positive fluid balance and decline in biomarkers of renal function are related to increased mortality, thus in this subpopulation of critically ill patients, positive fluid balance is not recommended and renal function must be closely monitored.

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Availability of data, material and code

All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Funding

This study did not receive any financial support for the conduct of the research and/or preparation of the article.

Author information

Authors and Affiliations

  1. Intensive Care Unit, National Institute of Neurology and Neurosurgery, 29 St. and D St., Vedado, Plaza, 10400, Havana, Cuba

    Frank Daniel Martos-Benítez, Raysa Caridad Cárdenas-González, Juan Carlos Michelena-Piedra, Judet Izquierdo-Castañeda, Ernesto Sánchez-de-la-Rosa & Olivia Corrales-González

  2. Intensive Care Unit-8, Hermanos Ameijeiras Hospital, San Lázaro St., Centro Havana, 10200, Havana, Cuba

    Dailé Burgos-Aragüez & Liselotte García-Mesa

  3. Intermediate Care Unit, Hospital of Palamos, 17230, Palamos, Spain

    Versis Orama-Requejo

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  1. Frank Daniel Martos-Benítez
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Contributions

All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for authorship. Conceptualization: FDM-B, DB-A, LG-M, VO-R; data curation: FDM-B, DB-A, LG-M, VO-R, RC. C-G, JCM-P, JI-C, ES-dlR; methodology: FDM-B, VO-R, ES-dlR, OC-G; formal analysis: FDM-B, ES-dlR, OC-G; writing–original draft: FDM-B, JCM-P; writing–review and editing: FDM-B, DB-A, LG-M, VO-R, RCC-G, JC M-P, JI-C, ES-dlR, OC-G.

Corresponding author

Correspondence to Frank Daniel Martos-Benítez.

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Conflict of interest

All authors declare that they have no conflicts of interest.

Human and animal rights

The study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was in accordance with the national and local ethical standards.

Ethics approval

The study protocol was reviewed by the Ethics Committee for Scientific Research of the “Hermanos Ameijeiras” Hospital, Cuba (Approval number 54/10–06-2016).

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The authors declare that this report does not contain any personal information that could lead to the identification of the patients. Written informed consent was obtained from all included patients.

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Martos-Benítez, F.D., Burgos-Aragüez, D., García-Mesa, L. et al. Fluid balance, biomarkers of renal function and mortality in critically ill patients with AKI diagnosed before, or within 24 h of intensive care unit admission: a prospective study. J Nephrol 37, 439–449 (2024). https://doi.org/10.1007/s40620-023-01829-z

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