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Chau K, Schisler T, Er L, et al. Fluid balance, change in serum creatinine and urine output as markers of acute kidney injury post cardiac surgery: an observational study. Can J Kidney Health Dis. 2014;1:19doi: 10.1186/s40697-014-0019-4.
Chau, K., Schisler, T., Er, L., Jaswal, D., Cheung, C., Israel, A., Bowering, J., & Levin, A. (2014). Fluid balance, change in serum creatinine and urine output as markers of acute kidney injury post cardiac surgery: an observational study. Canadian journal of kidney health and disease, 119. https://doi.org/10.1186/s40697-014-0019-4
Chau, Katrina, et al. "Fluid balance, change in serum creatinine and urine output as markers of acute kidney injury post cardiac surgery: an observational study." Canadian journal of kidney health and disease vol. 1 (2014): 19. doi: https://doi.org/10.1186/s40697-014-0019-4
Chau K, Schisler T, Er L, Jaswal D, Cheung C, Israel A, Bowering J, Levin A. Fluid balance, change in serum creatinine and urine output as markers of acute kidney injury post cardiac surgery: an observational study. Can J Kidney Health Dis. 2014 Sep 02;1:19. doi: 10.1186/s40697-014-0019-4. eCollection 2014. PMID: 25960885; PMCID: PMC4424577.
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Can J Kidney Health Dis. 2014 Sep 02;1:19. doi: 10.1186/s40697-014-0019-4. eCollection 2014.

Fluid balance, change in serum creatinine and urine output as markers of acute kidney injury post cardiac surgery: an observational study.

Canadian journal of kidney health and disease

Katrina Chau, Travis Schisler, Lee Er, Dharmvir Jaswal, Christopher Cheung, Amanda Israel, John Bowering, Adeera Levin

Affiliations

  1. Division of Nephrology, Faculty of Medicine, The University of British Columbia, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z1Y6 Canada.
  2. Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z1Y6 Canada.
  3. Faculty of Medicine, The University of British Columbia, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z1Y6 Canada.

PMID: 25960885 PMCID: PMC4424577 DOI: 10.1186/s40697-014-0019-4

Abstract

BACKGROUND: Acute kidney injury (AKI) is defined as oliguria or rise in serum creatinine but oliguria alone as a diagnostic criterion may over-diagnose AKI.

OBJECTIVES: Given the association between fluid overload and AKI, we aimed to determine if positive fluid balance can complement the known parameters in assessing outcomes of AKI.

DESIGN: Prospective observational study.

SETTING: Teaching hospital in Vancouver, Canada.

PATIENTS: 111 consecutive patients undergoing elective cardiac surgery from January to April 2012.

MEASUREMENTS: Outcomes of cardiac surgery intensive care unit (CSICU) and hospital length of stay (LOS) in relation to fluid balance, urine output and serum creatinine.

METHODS: All fluid input and output was recorded for 72 hours post-operatively. Positive fluid balance was defined as >6.5 cc/kg. Daily serum creatinine and hourly urine output were recorded and patients were defined as having AKI according to the AKIN criteria.

RESULTS: Of the patients who were oliguric, those with fluid overload trended towards longer LOS than those without fluid overload [CSICU LOS: 62 and 39 hours (unadjusted p-value 0.02, adjusted p-value 0.58); hospital LOS: 13 and 9 days (unadjusted p-value: 0.05, adjusted p-value: 0.16)]. Patients with oliguria who were fluid overloaded had similar LOS to patients with overt AKI (change in serum creatinine ≥ 26.5 µmol/L), [CSICU LOS: 62 and 69 hours (adjusted p value: 0.32) and hospital LOS: 13 and 14 days (adjusted p value: 0.19)]. Patients with oliguria regardless of fluid balance had longer CSICU LOS (adjusted p value: 0.001) and patients who were fluid overloaded in the absence of AKI had longer hospital LOS (adjusted p value: 0.02).

LIMITATIONS: Single centre, small sample, LOS as outcome.

CONCLUSIONS: Oliguria and positive fluid balance is associated with a trend towards longer LOS as compared to oliguria alone. Fluid balance may therefore be a useful marker of AKI, in addition to urine output and serum creatinine.

Keywords: Acute kidney injury; Cardiac surgery; Diagnosis; Fluid resuscitation

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