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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Fluid balance and chloride load in the first 24h of ICU admission and its relati...
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Vol. 64. Issue 5.
Pages 243-249 (May 2017)
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Vol. 64. Issue 5.
Pages 243-249 (May 2017)
Original article
Fluid balance and chloride load in the first 24h of ICU admission and its relation with renal replacement therapies through a multicentre, retrospective, case–control study paired by APACHE-II
Balance hídrico y carga de cloro en las primeras 24h de ingreso en UCI y su relación con las terapias de reemplazo renal mediante un estudio multicéntrico, retrospectivo, de casos y controles emparejados por APACHE-II
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A. González-Castroa,
Corresponding author
, M. Ortiz-Lasaa, O. Leizaolab, E. Salgadob, T. Irriguiblec, M. Sánchez-Satorrac, C. Lomas-Fernándezd, P. Barral-Segadee, M. Cordero-Vallejof, E. Rodrigo-Calabiag, T. Dierssen-Sotosh
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Servicio de Medicina Intensiva, Hospital Universitario de Cabueñes, Gijón, Spain
c Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Spain
d Servicio de Medicina Intensiva, Hospital Moisés Broggi, Sant Joan Despí, Spain
e Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
f Servicio de Medicina Intensiva, Hospital Universitario Araba, Vitoria, Spain
g Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
h Departamento de Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, Spain
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Statistics
Tables (4)
Table 1. Kidney failure classification by creatinine kinetics.
Table 2. Electrolytic distribution of different study solutions, in mmol/L.
Table 3. Clinical and demographic variables of stage 0 study patients according to creatinine kinetics, grouped as cases and controls, during the first 24h of admission.
Table 4. Analytical variables at admission and at 24h in stage 0 kinetic creatinine patients in the first 24h.
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Abstract
Objective

To analyse the association between water balance during the first 24h of admission to ICU and the variables related to chloride levels (chloride loading, type of fluid administered, hyperchloraemia), with the development of acute kidney injury renal replacement therapy (AKI-RRT) during patients’ admission to ICU.

Patients and methods

Multicentre case–control study. Hospital-based, national, carried out in 6 ICUs. Cases were patients older than 18 years who developed an AKI-RRT. Controls were patients older than 18 years admitted to the same institutions during the study period, who did not develop AKI-RRT during ICU admission. Pairing was done by APACHE-II. An analysis of unconditional logistic regression adjusted for age, sex, APACHE-II and water balance (in evaluating the type of fluid).

Results

We analysed the variables of 430 patients: 215 cases and 215 controls. An increase of 10% of the possibility of developing AKI-RRT per 500mL of positive water balance was evident (OR: 1.09 [95% CI: 1.05–1.14]; p<0.001). The study of mean values of chloride load administered did not show differences between the group of cases and controls (299.35±254.91 vs. 301.67±234.63; p=0.92).

Conclusions

The water balance in the first 24h of ICU admission relates to the development of IRA-TRR, regardless of chloraemia.

Keywords:
Resuscitation
Fluids
Chloraemia
Fluid balance
Acute kidney failure
Renal replacement therapy
Resumen
Objetivo

Analizar la asociación entre el balance hídrico durante las primeras 24h de ingreso en UCI y las variables relacionadas con los valores de cloro (carga de cloro, tipo de fluido administrado, hipercloremia), con el empleo de técnicas de reemplazo renal secundarias a insuficiencia renal aguda (IRA-TRR) durante el posterior ingreso en UCI de los enfermos.

Pacientes y métodos

Estudio multicéntrico de casos y controles, de base hospitalaria y ámbito nacional, llevado a cabo en 6 UCI. Los casos fueron pacientes mayores de 18 años que desarrollaron una IRA-TRR. Los controles fueron pacientes mayores de 18 años, ingresados en el mismo periodo y centro que los casos, que no desarrollaron IRA-TRR durante su ingreso en UCI. Se realizó emparejamiento por APACHE-II. Se llevó a cabo un análisis de regresión logística no condicional ajustada por edad, sexo, APACHE-II. Las variables de interés principales fueron: balance hídrico, carga de cloro administrada, e IRA-TRR.

Resultados

Se han analizado las variables de 310 enfermos. Se evidenció un aumento del 10% en la posibilidad de desarrollar IRA-TRR por cada 500mL de balance hídrico positivo (OR: 1,09 [IC 95%:1,05–1,14]; p<0,001). El estudio de los valores medios de carga administrada no evidenció diferencias entre el grupo de casos y de controles (299,35±254,91 frente a 301,67±234,63; p=0,92).

Conclusiones

El balance hídrico en las primeras 24h de ingreso en UCI se relaciona con el desarrollo de IRA-TRR, independientemente de la cloremia.

Palabras clave:
Reanimación
Fluidos
Cloremia
Balance hídrico
Insuficiencia renal
Técnicas de reemplazo renal

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