{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:51:57Z","timestamp":1791305517504,"version":"4.3.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To investigate the association between net ultrafiltration (NUF) rate and fluid balance changes with 28-day mortality in critically ill patients receiving continuous renal replacement therapy (CRRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN:<\/jats:title>\n                    <jats:p>Multicenter retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SETTING:<\/jats:title>\n                    <jats:p>Data from two European mixed medical-surgical ICUs: University Hospital Bern, Switzerland, and Amsterdam University Medical Center, the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Adult critically ill patients receiving CRRT for at least 24 hours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>INTERVENTIONS:<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MEASUREMENTS AND MAIN RESULTS:<\/jats:title>\n                    <jats:p>We studied 973 critically ill adults undergoing a total of 6914 days of CRRT. NUF rates and fluid balance changes were calculated from hourly data and categorized into four predefined groups. NUF rates were classified as no NUF, low (&lt; 1.01\u2009mL\/kg\/h), moderate (1.01\u20131.75\u2009mL\/kg\/h), or high (&gt; 1.75\u2009mL\/kg\/h). Fluid balance change was stratified as negative (&lt; \u22121.5\u2009L\/day), moderate negative (\u22121.5 to \u22120.5\u2009L\/day), neutral (\u22120.5 to 0.5\u2009L\/day), or positive (&gt; 0.5\u2009L\/day). Using multivariable regression, random forest modeling, and mediation analysis, we observed no independent association between NUF rate and 28-day mortality after accounting for fluid balance. Mediation analysis suggested that the apparent survival advantage observed among patients with higher NUF rates was largely mediated through achievement of a more negative fluid balance, rather than a direct effect of NUF rate itself. In contrast, more positive fluid balance changes were linked to adverse clinical outcomes including 28-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In this two-center cohort of CRRT patients, NUF rate was not independently associated with mortality. Instead, the key determinant of outcome was fluid balance change. These findings suggest clinicians should not make NUF decisions in isolation, but rather should be using NUF as a means to achieve patient-specific fluid balance targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007289","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:40:51Z","timestamp":1786545651000},"page":"2648-2659","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Net Ultrafiltration Rate and Mortality in Critically Ill Patients: A Multicenter Cohort Study With Analysis of Fluid Balance Changes"],"prefix":"10.1097","volume":"54","author":[{"given":"Nadine C.","family":"Monai","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen A.","family":"Pfortmueller","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg C.","family":"Schefold","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Cioccari","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland."},{"name":"Department of Intensive Care Medicine, Kantonsspital Aarau, Aarau, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5579-810X","authenticated-orcid":false,"given":"Martin","family":"Faltys","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"R1-20261006","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jcrc.2016.07.015","article-title":"What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine.","volume":"37","author":"Marshall","year":"2017","journal-title":"J Crit Care"},{"key":"R2-20261006","doi-asserted-by":"crossref","first-page":"e0226325","DOI":"10.1371\/journal.pone.0226325","article-title":"A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries.","volume":"15","author":"Melo","year":"2020","journal-title":"PLoS One"},{"key":"R3-20261006","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/s13054-018-2163-1","article-title":"Net ultrafiltration intensity and mortality in critically ill patients with fluid overload.","volume":"22","author":"Murugan","year":"2018","journal-title":"Crit Care"},{"key":"R4-20261006","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1097\/CCM.0b013e318246b9c6","article-title":"An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. Augmented Level of Replacement Therapy trial.","volume":"40","author":"Bellomo","year":"2012","journal-title":"Crit Care Med"},{"key":"R5-20261006","doi-asserted-by":"crossref","first-page":"e749","DOI":"10.1097\/CCM.0000000000002372","article-title":"Both positive and negative fluid balance may be associated with reduced long-term survival in the critically ill.","volume":"45","author":"Balakumar","year":"2017","journal-title":"Crit Care Med"},{"key":"R6-20261006","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1097\/CCM.0000000000004617","article-title":"Fluid overload and mortality in adult critical care patients\u2014A systematic review and meta-analysis of observational studies.","volume":"48","author":"Messmer","year":"2020","journal-title":"Crit Care Med"},{"key":"R7-20261006","doi-asserted-by":"crossref","first-page":"361","DOI":"10.5603\/AIT.2014.0060","article-title":"Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: A systematic review with suggestions for clinical practice.","volume":"46","author":"Malbrain","year":"2014","journal-title":"Anaesthesiol Intensive Ther"},{"key":"R8-20261006","doi-asserted-by":"crossref","first-page":"162","DOI":"10.5114\/ait.2021.105252","article-title":"Aiming for zero fluid accumulation: First, do no harm.","volume":"53","author":"Perez Nieto","year":"2021","journal-title":"Anaesthesiol Intensive Ther"},{"key":"R9-20261006","doi-asserted-by":"crossref","first-page":"18216","DOI":"10.1038\/s41598-021-97888-y","article-title":"Early restrictive fluid balance is associated with lower hospital mortality independent of acute disease severity in critically ill patients on CRRT.","volume":"11","author":"Uusalo","year":"2021","journal-title":"Sci Rep"},{"key":"R10-20261006","first-page":"1","article-title":"KDIGO clinical practice guideline for acute kidney injury.","volume":"2","year":"2012","journal-title":"Kidney Int Suppl"},{"key":"R11-20261006","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1093\/bja\/aeu297","article-title":"Indications and management of mechanical fluid removal in critical illness.","volume":"113","author":"Rosner","year":"2014","journal-title":"Br J Anaesth"},{"key":"R12-20261006","doi-asserted-by":"crossref","first-page":"154835","DOI":"10.1016\/j.jcrc.2024.154835","article-title":"The interaction of net ultrafiltration rate with urine output and fluid balance after continuous renal replacement therapy initiation: A multi-Centre study.","volume":"83","author":"White","year":"2024","journal-title":"J Crit Care"},{"key":"R13-20261006","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1038\/s41581-020-00358-3","article-title":"Ultrafiltration in critically ill patients treated with kidney replacement therapy.","volume":"17","author":"Murugan","year":"2021","journal-title":"Nat Rev Nephrol"},{"key":"R14-20261006","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1186\/s12882-020-02184-y","article-title":"Net ultrafiltration prescription survey in Europe.","volume":"21","author":"Lumlertgul","year":"2020","journal-title":"BMC Nephrol"},{"key":"R15-20261006","doi-asserted-by":"crossref","first-page":"e87","DOI":"10.1097\/CCM.0000000000004092","article-title":"Net ultrafiltration prescription and practice among critically ill patients receiving renal replacement therapy: A multinational survey of critical care practitioners.","volume":"48","author":"Murugan","year":"2020","journal-title":"Crit Care Med"},{"key":"R16-20261006","doi-asserted-by":"crossref","first-page":"e195418","DOI":"10.1001\/jamanetworkopen.2019.5418","article-title":"Association of net ultrafiltration rate with mortality among critically ill adults with acute kidney injury receiving continuous venovenous hemodiafiltration: A secondary analysis of the Randomized Evaluation of Normal vs Augmented Level (RENAL) of Renal Replacement Therapy trial: A secondary analysis of the randomized evaluation of normal vs augmented level (RENAL) of renal replacement therapy trial.","volume":"2","author":"Murugan","year":"2019","journal-title":"JAMA Netw Open"},{"key":"R17-20261006","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1159\/000510556","article-title":"Heterogeneity of effect of net ultrafiltration rate among critically ill adults receiving continuous Renal Replacement Therapy.","volume":"50","author":"Serpa Neto","year":"2021","journal-title":"Blood Purif"},{"key":"R18-20261006","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1164\/rccm.202011-4097LE","article-title":"Continuous renal replacement therapy: The interaction between fluid balance and Net ultrafiltration.","volume":"203","author":"Naorungroj","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"R19-20261006","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1159\/000535315","article-title":"Early net ultrafiltration during continuous renal replacement therapy: Impact of admission diagnosis and association with mortality.","volume":"53","author":"Sansom","year":"2024","journal-title":"Blood Purif"},{"key":"R20-20261006","doi-asserted-by":"crossref","first-page":"766557","DOI":"10.3389\/fmed.2021.766557","article-title":"The association of an early net ultrafiltration rate and 28-day mortality in patients receiving continuous kidney replacement therapy.","volume":"8","author":"Wu","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"R21-20261006","doi-asserted-by":"crossref","first-page":"101170","DOI":"10.1016\/j.aucc.2024.101170","article-title":"Association of net ultrafiltration intensity and clinical outcomes among critically ill patients receiving continuous renal replacement therapy: A systematic review, meta-analysis, and trial sequential analysis.","volume":"38","author":"Jin","year":"2025","journal-title":"Aust Crit Care"},{"key":"R22-20261006","first-page":"32","article-title":"Physiological changes after fluid bolus therapy in cardiac surgery patients: A propensity score matched case-control study.","volume":"26","author":"Faltys","year":"2024","journal-title":"Crit Care Resusc"},{"key":"R23-20261006","doi-asserted-by":"crossref","first-page":"e563","DOI":"10.1097\/CCM.0000000000004916","article-title":"Sharing ICU patient data responsibly under the Society of Critical Care Medicine\/European Society of Intensive Care Medicine Joint Data Science Collaboration: The Amsterdam University Medical Centers Database (AmsterdamUMCdb) example.","volume":"49","author":"Thoral","year":"2021","journal-title":"Crit Care Med"},{"key":"R26-20261006","doi-asserted-by":"crossref","first-page":"e0272913","DOI":"10.1371\/journal.pone.0272913","article-title":"Assessment of prescribed vs. achieved fluid balance during continuous renal replacement therapy and mortality outcome.","volume":"17","author":"Neyra","year":"2022","journal-title":"PLoS One"},{"key":"R27-20261006","doi-asserted-by":"crossref","first-page":"e075960","DOI":"10.1136\/bmjopen-2023-075960","article-title":"Restrictive versus Liberal Rate of Extracorporeal Volume Removal Evaluation in Acute Kidney Injury (RELIEVE-AKI): a pilot clinical trial protocol.","volume":"13","author":"Murugan","year":"2023","journal-title":"BMJ Open"}],"container-title":["Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/CCM.0000000000007289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:01:55Z","timestamp":1791302515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/CCM.0000000000007289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/ccm.0000000000007289","relation":{},"ISSN":["0090-3493","1530-0293"],"issn-type":[{"value":"0090-3493","type":"print"},{"value":"1530-0293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]}}}