Impact of Fluid Resuscitation in End-Stage Renal Disease Patients With Septic Shock
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Sepsis, Renal, Quality and Patient Safety, 2022
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INTRODUCTION:The 2016 Surviving Sepsis Campaign recommends at least 30 mL/kg of initial fluid resuscitation for all patients with septic shock. The guidelines do not address if the initial fluid resuscitation goal should be modified in patients with end-stage renal disease (ESRD). There is limited literature surrounding the optimal fluid resuscitation goal for septic shock patients with ESRD. METHODS:The purpose of this multicenter, retrospective, cohort study was to determine the clinical efficacy and safety of initial fluid resuscitation in ESRD patients who received >30 mL/kg vs < 30 mL/kg within the first three hours of septic shock recognition. All patients included in the analysis had to have a past medical history of ESRD, admitted to a medical intensive care unit and require vasopressor support for at least 60 minutes. The primary outcome was in-hospital mortality. Secondary outcomes included time to hemodynamic stability, duration of mechanical ventilation and renal replacement therapy, fluid intake, fluid balance, and ICU and hospital length of stay. A multivariable logistic regression was used to identify factors associated with in-hospital mortality. RESULTS:A total of 156 patients were included with 126 (80.8%) patients receiving < 30 mL/kg and 30 (19.2%) patients receiving >30 ml/kg of initial fluid. Average initial volume administered was 14 mL/kg vs 36 mL/kg. No difference was observed in the primary outcome of in-hospital mortality between groups (32.5% vs 36.7%; p=0.667). Secondary outcomes, including time to hemodynamic stability, duration of mechanical ventilation, and length of stay were similar between groups. In a multivariable regression analysis both appropriateness of antibiotics (p=0.03) and continuous renal replacement therapy (p=0.008) were significant predictors of in-hospital mortality. CONCLUSIONS:In-hospital mortality and other clinical outcomes were not different in ESRD patients with septic shock who received < 30 mL/kg compared to those who received >30 mL/kg of initial fluid resuscitation. Prospective studies are warranted to determine the optimal initial fluid resuscitation needed to experience the best patient outcomes in septic shock patients with ESRD.
Meta Tag
Content Type Presentation
Knowledge Area Sepsis
Knowledge Area Renal
Knowledge Area Quality and Patient Safety
Knowledge Level Foundational
Knowledge Level Intermediate
Knowledge Level Advanced
Learning Pathway Sepsis Resources
Membership Level Select
Tag Shock
Tag Renal
Tag Evidence Based Medicine
Year 2022
fluid resuscitation
end-stage renal disease
ESRD patients
septic shock
clinical efficacy
Quality and Patient Safety
Evidence Based Medicine
Sepsis Resources


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