Renal Recovery Linked to Pre-Dialysis Fluid Status

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LAS VEGAS—Pre-dialysis fluid status predicts the likelihood of renal recovery in patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT), researchers reported here at the National Kidney Foundation's Spring Clinical Meetings.

Lead investigator Michael Heung, MD, of the University of Michigan in Ann Arbor, and colleagues retrospectively studied 170 patients who developed acute tubular necrosis-related AKI requiring RRT. The researchers defined fluid status as the percent change in weight at dialysis initiation compared with baseline. They analyzed fluid status as both a continuous variable and categorical variable (less than 10% vs. 10% or more).

The mortality rate was 53% in the hospital and 65% at one year. Renal recovery (defined as dialysis independence) occurred in 69% of survivors. Patients who had renal recovery had an average 6.2% increase in fluid status at dialysis initiation compared with an 11.6% increase in those who did not have renal recovery. Each one unit increase in percent fluid overload was associated with a 3% decrease in the odds of renal recovery, according to the investigators. Patients with greater than 10% increase in fluid status were more than two times as likely to have non-recovery compared with those with a less than 10% increase in fluid status.

In addition, the investigators found that lack of renal recovery was associated with worse baseline creatinine, greater severity of illness, and one or more comorbidities.

“Based on our results, further studies evaluating conservative fluid management strategies and looking at the impact of fluid removal strategies on renal recovery would help clinicians guide therapy in AKI requiring RRT,” the authors concluded.

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