An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial

Rinaldo Bellomo, Alan Cass, Louise Cole, Simon Finfer, Martin Gallagher, Joanne Lee, Serigne Lo, Colin McArthur, Shay McGuinness, John Myburgh, Robyn Norton, Carlos Scheinkestel

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To examine associations between mean daily fluid balance during intensive care unit study enrollment and clinical outcomes in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) replacement therapy study.

    Design: Statistical analysis of data from multicenter, randomized, controlled trials.

    Setting: Thirty-five intensive care units in Australia and New Zealand.

    Patients: Cohort of 1453 patients enrolled in the RENAL study.

    Interventions: We analyzed the association between daily fluid balance on clinical outcomes using multivariable logistic regression, Cox proportional hazards, time-dependent analysis, and repeated measure analysis models.

    Measurements and Main Results: During intensive care unit stay, mean daily fluid balance among survivors was -234 mL/day compared with +560 mL/day among nonsurvivors (p < .0001). Mean cumulative fluid balance over the same period was -1941 vs. +1755 mL (p = .0003). A negative mean daily fluid balance during study treatment was independently associated with a decreased risk of death at 90 days (odds ratio 0.318; 95% confidence interval 0.24-0.43; p < .000.1) and with increased survival time (p < .0001). In addition, a negative mean daily fluid balance was associated with significantly increased renal replacement-free days (p = .0017), intensive care unit-free days (p < .0001), and hospital-free days (p = .01). These findings were unaltered after the application of different statistical models.

    Conclusions: In the RENAL study, a negative mean daily fluid balance was consistently associated with improved clinical outcomes. Fluid balance may be a target for specific manipulation in future interventional trials of critically ill patients receiving renal replacement therapy.
    Original languageEnglish
    Pages (from-to)1753-1760
    Number of pages8
    JournalCritical Care Medicine
    Volume40
    Issue number6
    DOIs
    Publication statusPublished - 2012

    Fingerprint

    Water-Electrolyte Balance
    Observational Studies
    Intensive Care Units
    Therapeutics
    Statistical Data Interpretation
    Renal Replacement Therapy
    Statistical Models
    New Zealand
    Critical Illness
    Survivors
    Randomized Controlled Trials
    Logistic Models
    Odds Ratio
    Confidence Intervals
    Kidney
    Survival

    Cite this

    Bellomo, Rinaldo ; Cass, Alan ; Cole, Louise ; Finfer, Simon ; Gallagher, Martin ; Lee, Joanne ; Lo, Serigne ; McArthur, Colin ; McGuinness, Shay ; Myburgh, John ; Norton, Robyn ; Scheinkestel, Carlos. / An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial. In: Critical Care Medicine. 2012 ; Vol. 40, No. 6. pp. 1753-1760.
    @article{deffd12df87346aa9f1ac9536a835543,
    title = "An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial",
    abstract = "Objective: To examine associations between mean daily fluid balance during intensive care unit study enrollment and clinical outcomes in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) replacement therapy study.Design: Statistical analysis of data from multicenter, randomized, controlled trials.Setting: Thirty-five intensive care units in Australia and New Zealand.Patients: Cohort of 1453 patients enrolled in the RENAL study.Interventions: We analyzed the association between daily fluid balance on clinical outcomes using multivariable logistic regression, Cox proportional hazards, time-dependent analysis, and repeated measure analysis models.Measurements and Main Results: During intensive care unit stay, mean daily fluid balance among survivors was -234 mL/day compared with +560 mL/day among nonsurvivors (p < .0001). Mean cumulative fluid balance over the same period was -1941 vs. +1755 mL (p = .0003). A negative mean daily fluid balance during study treatment was independently associated with a decreased risk of death at 90 days (odds ratio 0.318; 95{\%} confidence interval 0.24-0.43; p < .000.1) and with increased survival time (p < .0001). In addition, a negative mean daily fluid balance was associated with significantly increased renal replacement-free days (p = .0017), intensive care unit-free days (p < .0001), and hospital-free days (p = .01). These findings were unaltered after the application of different statistical models.Conclusions: In the RENAL study, a negative mean daily fluid balance was consistently associated with improved clinical outcomes. Fluid balance may be a target for specific manipulation in future interventional trials of critically ill patients receiving renal replacement therapy.",
    author = "Rinaldo Bellomo and Alan Cass and Louise Cole and Simon Finfer and Martin Gallagher and Joanne Lee and Serigne Lo and Colin McArthur and Shay McGuinness and John Myburgh and Robyn Norton and Carlos Scheinkestel",
    year = "2012",
    doi = "10.1097/CCM.0b013e318246b9c6",
    language = "English",
    volume = "40",
    pages = "1753--1760",
    journal = "Critical Care Medicine",
    issn = "0090-3493",
    publisher = "Lippincott Williams & Wilkins",
    number = "6",

    }

    Bellomo, R, Cass, A, Cole, L, Finfer, S, Gallagher, M, Lee, J, Lo, S, McArthur, C, McGuinness, S, Myburgh, J, Norton, R & Scheinkestel, C 2012, 'An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial', Critical Care Medicine, vol. 40, no. 6, pp. 1753-1760. https://doi.org/10.1097/CCM.0b013e318246b9c6

    An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial. / Bellomo, Rinaldo; Cass, Alan; Cole, Louise; Finfer, Simon; Gallagher, Martin; Lee, Joanne; Lo, Serigne; McArthur, Colin; McGuinness, Shay; Myburgh, John; Norton, Robyn; Scheinkestel, Carlos.

    In: Critical Care Medicine, Vol. 40, No. 6, 2012, p. 1753-1760.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial

    AU - Bellomo, Rinaldo

    AU - Cass, Alan

    AU - Cole, Louise

    AU - Finfer, Simon

    AU - Gallagher, Martin

    AU - Lee, Joanne

    AU - Lo, Serigne

    AU - McArthur, Colin

    AU - McGuinness, Shay

    AU - Myburgh, John

    AU - Norton, Robyn

    AU - Scheinkestel, Carlos

    PY - 2012

    Y1 - 2012

    N2 - Objective: To examine associations between mean daily fluid balance during intensive care unit study enrollment and clinical outcomes in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) replacement therapy study.Design: Statistical analysis of data from multicenter, randomized, controlled trials.Setting: Thirty-five intensive care units in Australia and New Zealand.Patients: Cohort of 1453 patients enrolled in the RENAL study.Interventions: We analyzed the association between daily fluid balance on clinical outcomes using multivariable logistic regression, Cox proportional hazards, time-dependent analysis, and repeated measure analysis models.Measurements and Main Results: During intensive care unit stay, mean daily fluid balance among survivors was -234 mL/day compared with +560 mL/day among nonsurvivors (p < .0001). Mean cumulative fluid balance over the same period was -1941 vs. +1755 mL (p = .0003). A negative mean daily fluid balance during study treatment was independently associated with a decreased risk of death at 90 days (odds ratio 0.318; 95% confidence interval 0.24-0.43; p < .000.1) and with increased survival time (p < .0001). In addition, a negative mean daily fluid balance was associated with significantly increased renal replacement-free days (p = .0017), intensive care unit-free days (p < .0001), and hospital-free days (p = .01). These findings were unaltered after the application of different statistical models.Conclusions: In the RENAL study, a negative mean daily fluid balance was consistently associated with improved clinical outcomes. Fluid balance may be a target for specific manipulation in future interventional trials of critically ill patients receiving renal replacement therapy.

    AB - Objective: To examine associations between mean daily fluid balance during intensive care unit study enrollment and clinical outcomes in patients enrolled in the Randomized Evaluation of Normal vs. Augmented Level (RENAL) replacement therapy study.Design: Statistical analysis of data from multicenter, randomized, controlled trials.Setting: Thirty-five intensive care units in Australia and New Zealand.Patients: Cohort of 1453 patients enrolled in the RENAL study.Interventions: We analyzed the association between daily fluid balance on clinical outcomes using multivariable logistic regression, Cox proportional hazards, time-dependent analysis, and repeated measure analysis models.Measurements and Main Results: During intensive care unit stay, mean daily fluid balance among survivors was -234 mL/day compared with +560 mL/day among nonsurvivors (p < .0001). Mean cumulative fluid balance over the same period was -1941 vs. +1755 mL (p = .0003). A negative mean daily fluid balance during study treatment was independently associated with a decreased risk of death at 90 days (odds ratio 0.318; 95% confidence interval 0.24-0.43; p < .000.1) and with increased survival time (p < .0001). In addition, a negative mean daily fluid balance was associated with significantly increased renal replacement-free days (p = .0017), intensive care unit-free days (p < .0001), and hospital-free days (p = .01). These findings were unaltered after the application of different statistical models.Conclusions: In the RENAL study, a negative mean daily fluid balance was consistently associated with improved clinical outcomes. Fluid balance may be a target for specific manipulation in future interventional trials of critically ill patients receiving renal replacement therapy.

    U2 - 10.1097/CCM.0b013e318246b9c6

    DO - 10.1097/CCM.0b013e318246b9c6

    M3 - Article

    VL - 40

    SP - 1753

    EP - 1760

    JO - Critical Care Medicine

    JF - Critical Care Medicine

    SN - 0090-3493

    IS - 6

    ER -