Fluid overload greater than 20% at the start of continuous renal replacement therapy (CRRT) increases the risk of death among pediatric ICU patients with acute kidney injury, researchers concluded.

Leslie W. Hayes, MD, and collaborators at the University of Alabama at Birmingham examined outcomes among 76 pediatric patients (mean age 5.8 years) who required CRRT during the study period.

Overall survival was 55.3%, according to a report in the Journal of Critical Care (2009; published online ahead of print). The median percentage of fluid overload at the time of CRRT initiation was 7.3% among survivors compared with 22.3% in those who died.

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In addition, the study showed that multiple organ dysfunction syndrome (MODS) was associated with increased mortality risk. All of the deceased patients had MODS vs. 69% of survivors.

Survivors who had fluid overload greater than 20% had a significant prolonged time to renal recovery as well as longer ICU and hospital stays and duration of mechanical ventilation.