{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T06:35:42Z","timestamp":1793860542964,"version":"4.6.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Fluid overload (FO) with coincident acute kidney injury has been associated with increased mortality. However, it is unclear whether FO is an independent determinant of mortality for disease severity. We aimed to explore whether the development of fluid balance (FB) during the first 72\u00a0h of continuous renal replacement therapy (CRRT) is independently associated with hospital mortality. All patients admitted to a single centre ICU requiring CRRT for at least 24\u00a0h between years 2010\u20132019 were included. Extracted data included patient demographics and clinical parameters including daily cumulative fluid balance (FB\n                    <jats:sup>cum<\/jats:sup>\n                    ), lactate, SOFA score and vasoactive requirement at the initiation and during the first 72\u00a0h of CRRT. 399 patients were included in the analysis. Hospital survivors had a significantly lower FB\n                    <jats:sup>cum<\/jats:sup>\n                    at CRRT initiation compared to non-survivors (median 1382 versus 3265\u00a0ml; p\u2009=\u20090.003). Hourly fluid balance per bodyweight (FB\n                    <jats:sup>net<\/jats:sup>\n                    ) was lower in survivors at 0\u201324, 24\u201348 and 48\u201372\u00a0h after initiation of CRRT (p\u2009&lt;\u20090.008 for all comparisons). In the survival analysis (analyzed with counting process model) significant time-dependent explanatory variables for hospital mortality were FB\n                    <jats:sup>net<\/jats:sup>\n                    (per ml\/kg\/h: HR: 1.319, 95% CI 1.038\u20131.677, p\u2009=\u20090.02), lactate (HR: 1.086, 95% CI 1.030\u20131.145, p\u2009=\u20090.002) and SOFA score (per ml\/kg\/h: HR: 1.084, 95% CI 1.025\u20131.146, p\u2009=\u20090.005) during the first 72\u00a0h of CRRT. Even after careful adjustment for repeated measures of disease severity, FB\n                    <jats:sup>net<\/jats:sup>\n                    during the first 72\u00a0h of CRRT remains independently associated with hospital mortality, in critically ill patients with AKI.\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-97888-y","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T06:03:16Z","timestamp":1631599396000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT"],"prefix":"10.1038","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5120-8854","authenticated-orcid":false,"given":"Panu","family":"Uusalo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tapio","family":"Hellman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliisa","family":"L\u00f6yttyniemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Peltoniemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko J.","family":"J\u00e4rvisalo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"issue":"4","key":"97888_CR1","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1038\/ki.2009.159","volume":"76","author":"J Bouchard","year":"2009","unstructured":"Bouchard, J. et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 76(4), 422\u2013427. https:\/\/doi.org\/10.1038\/ki.2009.159 (2009).","journal-title":"Kidney Int."},{"issue":"5","key":"97888_CR2","doi-asserted-by":"publisher","first-page":"R197","DOI":"10.1186\/cc11682","volume":"16","author":"ST Vaara","year":"2012","unstructured":"Vaara, S. T. et al. Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. Crit. Care 16(5), R197. https:\/\/doi.org\/10.1186\/cc11682 (2012).","journal-title":"Crit. Care"},{"issue":"9","key":"97888_CR3","doi-asserted-by":"publisher","first-page":"e753","DOI":"10.1097\/ccm.0000000000003862","volume":"47","author":"CW Woodward","year":"2019","unstructured":"Woodward, C. W. et al. Fluid overload associates with major adverse kidney events in critically Ill patients with acute kidney injury requiring continuous renal replacement therapy. Crit. Care Med. 47(9), e753\u2013e760. https:\/\/doi.org\/10.1097\/ccm.0000000000003862 (2019).","journal-title":"Crit. Care Med."},{"key":"97888_CR4","doi-asserted-by":"publisher","unstructured":"Investigators RRTS, Bellomo R, Cass A, et al. An observational study fluid balance and patient outcomes in the randomized evaluation of normal vs. augmented level of replacement therapy trial&ast; Crit. Care Med. 2012;40(6):1753\u20131760. https:\/\/doi.org\/10.1097\/ccm.0b013e318246b9c6","DOI":"10.1097\/ccm.0b013e318246b9c6"},{"issue":"1","key":"97888_CR5","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1186\/s12882-020-02184-y","volume":"21","author":"N Lumlertgul","year":"2020","unstructured":"Lumlertgul, N., Murugan, R., Seylanova, N., McCready, P. & Ostermann, M. Net ultrafiltration prescription survey in Europe. BMC Nephrol. 21(1), 522. https:\/\/doi.org\/10.1186\/s12882-020-02184-y (2020).","journal-title":"BMC Nephrol."},{"key":"97888_CR6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jcrc.2019.07.004","volume":"54","author":"K Shawwa","year":"2019","unstructured":"Shawwa, K. et al. Hypotension within one-hour from starting CRRT is associated with in-hospital mortality. J. Crit. Care 54, 7\u201313. https:\/\/doi.org\/10.1016\/j.jcrc.2019.07.004 (2019).","journal-title":"J. Crit. Care"},{"issue":"6","key":"97888_CR7","doi-asserted-by":"publisher","first-page":"e195418","DOI":"10.1001\/jamanetworkopen.2019.5418","volume":"2","author":"R Murugan","year":"2019","unstructured":"Murugan, R. et al. Association of net ultrafiltration rate with mortality among critically Ill adults with acute kidney injury receiving continuous venovenous hemodiafiltration. JAMA Netw Open 2(6), e195418. https:\/\/doi.org\/10.1001\/jamanetworkopen.2019.5418 (2019).","journal-title":"JAMA Netw Open"},{"key":"97888_CR8","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfaa032","author":"T Naorungroj","year":"2020","unstructured":"Naorungroj, T. et al. Early net ultrafiltration rate and mortality in critically ill patients receiving continuous renal replacement therapy. Nephrol. Dial. Transpl.  https:\/\/doi.org\/10.1093\/ndt\/gfaa032 (2020).","journal-title":"Nephrol. Dial. Transpl."},{"issue":"2","key":"97888_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0172137","volume":"12","author":"IY Kim","year":"2017","unstructured":"Kim, I. Y. et al. Fluid overload and survival in critically ill patients with acute kidney injury receiving continuous renal replacement therapy. PLoS ONE 12(2), e0172137. https:\/\/doi.org\/10.1371\/journal.pone.0172137 (2017).","journal-title":"PLoS ONE"},{"issue":"1","key":"97888_CR10","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/s13054-018-2163-1","volume":"22","author":"R Murugan","year":"2018","unstructured":"Murugan, R. et al. Net ultrafiltration intensity and mortality in critically ill patients with fluid overload. Crit. Care 22(1), 223. https:\/\/doi.org\/10.1186\/s13054-018-2163-1 (2018).","journal-title":"Crit. Care"},{"issue":"2","key":"97888_CR11","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1093\/ckj\/sfz179","volume":"14","author":"S Tehranian","year":"2019","unstructured":"Tehranian, S., Shawwa, K. & Kashani, K. B. Net ultrafiltration rate and its impact on mortality in patients with acute kidney injury receiving continuous renal replacement therapy. Clin. Kidney J. 14(2), 564\u2013569. https:\/\/doi.org\/10.1093\/ckj\/sfz179 (2019).","journal-title":"Clin. Kidney J."},{"key":"97888_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41581-020-00358-3","volume":"66","author":"R Murugan","year":"2020","unstructured":"Murugan, R., Bellomo, R., Palevsky, P. M. & Kellum, J. A. Ultrafiltration in critically ill patients treated with kidney replacement therapy. Nat. Rev. Nephrol. 66, 1\u201315. https:\/\/doi.org\/10.1038\/s41581-020-00358-3 (2020).","journal-title":"Nat. Rev. Nephrol."},{"issue":"1","key":"97888_CR13","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1186\/s13054-019-2633-0","volume":"23","author":"JH Jhee","year":"2019","unstructured":"Jhee, J. H. et al. The interactive effects of input and output on managing fluid balance in patients with acute kidney injury requiring continuous renal replacement therapy. Crit. Care 23(1), 329. https:\/\/doi.org\/10.1186\/s13054-019-2633-0 (2019).","journal-title":"Crit. 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