Sepsis-associated acute kidney injury (AKI) is a common and serious complication in critically ill patients, with mortality rates ranging from 40% to 60%. Continuous renal replacement therapy (CRRT) is a widely used treatment for AKI in these patients, but the optimal volume control strategy during CRRT remains a topic of debate.
A recent randomized controlled trial (RCT) and secondary analysis sought to investigate the impact of volume control strategy on patient survival in sepsis-associated AKI with CRRT. The study included 300 critically ill patients with sepsis-associated AKI who were randomized to receive either a conservative or liberal volume control strategy during CRRT.
The conservative volume control strategy aimed to achieve a negative fluid balance by removing more fluid than was being administered, while the liberal strategy aimed to maintain a neutral or positive fluid balance. The primary outcome of the study was patient survival at 28 days, with secondary outcomes including renal recovery, duration of mechanical ventilation, and length of stay in the intensive care unit.
The results of the study showed that patients in the conservative volume control group had significantly higher survival rates at 28 days compared to those in the liberal volume control group. Additionally, patients in the conservative group had a higher rate of renal recovery and shorter duration of mechanical ventilation and ICU stay.
These findings suggest that a conservative volume control strategy during CRRT may improve patient outcomes in sepsis-associated AKI. By achieving a negative fluid balance, the conservative strategy may help to prevent fluid overload, which is associated with increased mortality and morbidity in critically ill patients.
It is important to note that individualized fluid management is crucial in the treatment of sepsis-associated AKI, and the optimal volume control strategy may vary depending on the patient’s clinical status and response to treatment. Further research is needed to confirm these findings and determine the long-term impact of volume control strategies on patient outcomes in sepsis-associated AKI with CRRT.
In conclusion, the results of this RCT and secondary analysis suggest that a conservative volume control strategy during CRRT may improve patient survival and other outcomes in sepsis-associated AKI. Clinicians should consider individualized fluid management strategies based on the patient’s clinical status and response to treatment in order to optimize outcomes in this high-risk population.
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- Source: Plato Data Intelligence.
- Source: https://renal.platohealth.ai/volume-control-strategy-and-patient-survival-in-sepsis-associated-acute-kidney-injury-receiving-continuous-renal-replacement-therapy-a-randomized-controlled-trial-with-secondary-analysis-scientific/