Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania.
Hospital of Lithuanian University of Health Sciences, Eivenių 2, LT-50161 Kaunas, Lithuania.
Medicina (Kaunas). 2021 May 22;57(6):518. doi: 10.3390/medicina57060518.
Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm HO. According to bioimpedance analysis, 72.3% ( = 34) of patients were hyperhydrated. According to CVP, only 51.1% ( = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% ( = 27) died, in 29.8% ( = 14) the kidney function improved, and in 12.8% ( = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed.
液体失衡与并发急性肾损伤（AKI）的危重症患者的不良结局相关。本研究旨在使用生物电阻抗分析（BIA）和中心静脉压（CVP）测量评估液体状态，并评估过度水化和血容量过多与严重 AKI 结局之间的关系。前瞻性研究在立陶宛健康科学大学考纳斯临床医院进行。检查了在重症监护病房（ICU）接受严重 AKI 治疗且需要肾脏替代治疗（RRT）的 47 名患者。根据生物电阻抗分析的细胞外液与总体水（ECW/TBW）比值评估水化水平，并根据 CVP 测量血容量。所有患者在第一次血液透析（HD）前均接受检测。将过度水化定义为 ECW/TBW＞0.39，血容量过多定义为 CVP＞12 cmH2O。根据生物电阻抗分析，72.3%（=34）的患者过度水化。根据 CVP，只有 51.1%（=24）的患者血容量过多。有趣的是，69.6%的低血容量/正常血容量患者也过度水化。在所有研究患者中，57.4%（=27）死亡，29.8%（=14）肾功能改善，12.8%（=6）住院治疗后仍需要 RRT。观察到过度水化患者的死亡率较高的趋势，但未发现血容量过多与严重 AKI 结局之间存在关联。根据生物电阻抗分析，四分之三的严重 AKI 患者过度水化。然而，根据 CVP，只有一半的患者血容量过多。观察到过度水化患者的死亡率较高的趋势。
