Fluid Balance in Patients With COVID-19 and AKI

In patients with acute kidney injury (AKI) related to severe COVID-19 infection, the optimal amount of hydration has not been established. Pranav Sharma, MD, and colleagues at Robert Wood Johnson University Hospital, New Brunswick, New Jersey, conducted a retrospective chart review and analysis to examine the impact of fluid management strategy on outcomes in patients with AKI and respiratory failure associated with COVID-19.

Results were reported during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled A Retrospective Analysis of Fluid Balance in Patients With AKI and Respiratory Failure Due to COVID-19.

The chart review included patients with hypoxia due to COVID-19 and AKI stage 2 or greater. The primary outcome of interest was the difference in net fluid balance between patients who were successfully weaned to lower levels of oxygen support and discharged compared with patients who died or remained dependent on ventilator therapy.

The analysis included 58 cases. Of those, 41 died, three remained ventilator-dependent, and 14 were discharged without the need for supplemental oxygen. There was a difference in net fluid balance between the groups (–10,065 cc vs +7,908 cc; P<.001) and in daily fluid balance (–367 cc/day vs 515 cc/day; P<.001).

There was a substantially lower fluid balance in patients who survived with minimal requirement for supplemental oxygen. Patients who maintained a positive fluid balance were significantly more likely to die or become ventilator-dependent (odds ratio, 40.7; 95% CI, 5.3-312.9). There was no reduction in the likelihood of recovery from AKI or an increase in the need for renal replacement therapy with a strategy of fluid restriction.

In conclusion, the authors said, “In our cohort, patients with COVID-19 and AKI who survived with minimal or no oxygen requirements tended to have negative fluid balance in contrast to those who died or remained ventilator-dependent. A fluid restrictive strategy with judicious volume removal using diuretics or dialysis may lead to improved outcomes in COVID-19 patients with AKI.”

Source: Sharma P, Bhagat AM, Madu C, Lebowitz J, Saro-Nunez L, Khalil SI. A retrospective analysis of fluid balance in patients with AKI and respiratory failure due to COVID-19. TH-PO078. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 3, 2022; Orlando, Florida.