Perfusion-based deresuscitation during continuous renal replacement therapy: A before-after pilot study (The early dry Cohort)

Abstract

BackgroundActive fluid removal has been suggested to improve prognosis following the resolution of acute circulatory failure. We have implemented a routine care protocol to guide fluid removal during continuous renal replacement therapy (CRRT). We designed a before-after pilot study to evaluate the impact of this deresuscitation strategy on the fluid balance. MethodsConsecutive ICU patients suffering from fluid overload and undergoing CRRT for acute kidney injury underwent a perfusion-based deresuscitation protocol combining a restrictive intake, net ultrafiltration (UFnet) of 2 mL/kg/h, and monitoring of perfusion (early dry group, N = 42) and were compared to a historical group managed according to usual practices (control group, N = 45). The primary outcome was the cumulative fluid balance at day 5 or at discharge. ResultsAdjusted cumulative fluid balance was significantly lower in the early dry group (median [IQR]: −7784 [−11,833 to −2933] mL) compared to the control group (−3492 [−9935 to −1736] mL; p = 0.04). The difference was mainly driven by a greater daily UFnet (31 [22–46] mL/kg/day vs. 24 [15–32] mL/kg/day; p = 0.01). There was no significant difference between both groups regarding hemodynamic tolerance. ConclusionOur perfusion-based deresuscitation protocol achieved a greater negative cumulative fluid balance compared to standard practices and was hemodynamically well tolerated.