• Thummaporn Naorungroj, NetoAry SerpaASDepartment of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.Department of Intensive Care, Amsterdam University Medical Center, Ams, Lara Zwakman-Hessels, Fumitaka Yanase, Glenn Eastwood, Raghavan Murugan, John A Kellum, and Rinaldo Bellomo.
• Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
• Nephrol. Dial. Transplant. 2021 May 27; 36 (6): 1112-1119.

BackgroundIn patients treated with continuous renal replacement therapy (CRRT), early net ultrafiltration (NUF) rates may be associated with differential outcomes. We tested whether higher early NUF rates are associated with increased mortality in CRRT patients.MethodsWe performed a retrospective, observational study of all patients treated with CRRT within 14 days of intensive care unit admission. We defined the early (first 48 h) NUF rate as the volume of fluid removed per hour adjusted for patient body weight and analysed as a categorical variable (>1.75, 1.01-1.75 and <1.01 mL/kg/h). The primary outcome was 28-day mortality. To deal with competing risk, we also compared different time epochs.ResultsWe studied 347 patients {median age 64 [interquartile range (IQR) 53-71] years and Acute Physiology and Chronic Health Evaluation III score 73 [IQR 54-90]}. Compared with NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h were associated with greater mortality rates in each epoch: Days 0-5, adjusted hazard ratio (aHR) 1.27 [95% confidence interval (CI) 1.21-1.33]; Days 6-10, aHR 1.62 (95% CI 1.55-1.68); Days 11-15, aHR 1.87 (95% CI 1.79-1.94); Days 16-26, aHR 1.92 (95% CI 1.84-2.01) and Days 27-28, aHR 4.18 (95% CI 3.98-4.40). For every 0.5 mL/kg/h NUF rate increase, mortality similarly increased during these epochs.ConclusionCompared with early NUF rates <1.01 mL/kg/h, NUF rates >1.75 mL/kg/h are associated with increased mortality. These observations provide the rationale for clinical trials to confirm or refute these findings.© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

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