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      Positive fluid balance as an early biomarker for acute kidney injury: a prospective study in critically ill adult patients

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          Abstract

          OBJECTIVES:

          Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients.

          METHODS:

          This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria.

          RESULTS:

          The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days.

          CONCLUSION:

          These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.

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          Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group

          Rinaldo Bellomo, Claudio Ronco, John A. Kellum … (2004)
          Introduction There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. Methods We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. Results We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at ) Conclusion Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.
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            2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.

            Mitchell Levy, Mitchell P Fink, John C Marshall … (2003)
            In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were "to provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well." The general definitions introduced as a result of that conference have been widely used in practice and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. Several North American and European intensive care societies agreed to revisit the definitions for sepsis and related conditions. This conference was sponsored by the SCCM, The European Society of Intensive Care Medicine (ESICM), The American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Surgical Infection Society (SIS). The conference was attended by 29 participants from Europe and North America. In advance of the conference, five subgroups were formed to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiologic data, and coagulation parameters. The subgroups corresponded electronically before the conference and met in person during the conference. A spokesperson for each group presented the deliberation of each group to all conference participants during a plenary session. A writing committee was formed at the conference and developed the current article based on executive summary documents generated by each group and the plenary group presentations. The present article serves as the final report of the 2001 International Sepsis Definitions Conference. This document reflects a process whereby a group of experts and opinion leaders revisited the 1992 sepsis guidelines and found that apart from expanding the list of signs and symptoms of sepsis to reflect clinical bedside experience, no evidence exists to support a change to the definitions. This lack of evidence serves to underscore the challenge still present in diagnosing sepsis in 2003 for clinicians and researchers and also provides the basis for introducing PIRO as a hypothesis-generating model for future research.
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              Notice

              Vlado Perkovic (2012)
              SECTION I: USE OF THE CLINICAL PRACTICE GUIDELINE This Clinical Practice Guideline document is based upon the best information available as of February 2011. It is designed to provide information and assist decision-making. It is not intended to define a standard of care, and should not be construed as one, nor should it be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every health-care professional making use of these recommendations is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. The recommendations for research contained within this document are general and do not imply a specific protocol. SECTION II: DISCLOSURE Kidney Disease: Improving Global Outcomes (KDIGO) makes every effort to avoid any actual or reasonably perceived conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the Work Group. All members of the Work Group are required to complete, sign, and submit a disclosure and attestation form showing all such relationships that might be perceived or actual conflicts of interest. This document is updated annually and information is adjusted accordingly. All reported information is published in its entirety at the end of this document in the Work Group members' Biographical and Disclosure Information section, and is kept on file at the National Kidney Foundation (NKF), Managing Agent for KDIGO.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clinics (Sao Paulo)
                Journal ID (iso-abbrev): Clinics (Sao Paulo)
                Journal ID (publisher-id): clin
                Title: Clinics
                Publisher: Faculdade de Medicina / USP
                ISSN (Print): 1807-5932
                ISSN (Electronic): 1980-5322
                Publication date (Electronic): 01 February 2021
                Publication date (Print): 2021
                Volume: 76
                Electronic Location Identifier: e1924
                Affiliations
                [I ]LIM 12, Disciplina de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
                [II ]Monte Tabor Hospital Sao Rafael, Salvador, BA, BR
                [III ]Medicina Interna e Apoio Diagnostico, Universidade Federal da Bahia, Salvador, BA, BR
                [IV ]Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
                [V ]Universidade do Estado da Bahia, Salvador, BA, BR
                [VI ]Escola Bahiana de Medicina e Saude Publica, Salvador, BA, BR
                [VII ]Faculdade de Medicina, Uniao Metropolitana de Educacao e Cultura UNIME/KROTON, Lauro de Freitas, BA, BR
                Author notes
                *Corresponding author. E-mail: olindaavila@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0001-7818-7344
                https://orcid.org/0000-0001-9598-6711
                https://orcid.org/0000-0002-1961-8439
                https://orcid.org/0000-0001-7854-4540
                https://orcid.org/0000-0003-3394-1774
                https://orcid.org/0000-0001-9102-0063
                https://orcid.org/0000-0002-7273-5087
                https://orcid.org/0000-0002-7644-8579
                Article
                Publisher ID: cln_76p1
                DOI: 10.6061/clinics/2021/e1924
                PMC ID: 7847255
                SO-VID: 14924fd7-7c42-4f42-9550-4145f4b86d22
                Copyright © Copyright © 2021 CLINICS
                License:

                This is an Open Access article distributed under the terms of the Creative Commons License ( http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

                History
                Date received : 20 April 2020
                Date accepted : 16 December 2020
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Medicine
                Keywords: acute kidney injury,biomarker,positive fluid balance,water balance,intensive care unit,mortality
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: acute kidney injury, biomarker, positive fluid balance, water balance, intensive care unit, mortality

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