January 30, 2019

AKI Section Article Review - EJRC

A restrospective, observational study


Net ultrafiltration intensity > 25 ml/kg/day associated with lower 1-year risk adjusted mortality

Fluid overload is common among critically ill patients with Acute Kidney Injury requiring renal replacement therapy. Fluid overload itself has a strong correlation with mortality among patients receiving Renal Replacement Therapy (RRT). Determination of the optimal intensity of net ultrafiltration (UFNET) during RRT can influence the short- and long-term patient outcomes.

This retrospective, observational study involving patients receiving RRT with an initial fluid overload >5% examined the association between net ultrafiltration intensity and risk-adjusted 1-year mortality.

The results confirmed that crude hospital and one-year mortality was higher among the low intensity group compared with moderate and high-intensity UFNET groups. High intensity (> 25 ml/kg/day) UFNET was associated with lower one-year mortality.  This study suggests that tolerating a higher UFNET may be the predictor of recovery and lower mortality in critically ill patients with fluid overload. If the capability to tolerate higher UFNET is a marker of recovery as a mediator needs further investigations.



This is the first study in the literature which investigated the association between UFNET intensity and long-term mortality, which first tried to determine the optimal intensity of UFNET.



Among critically ill patients with a fluid overload > 5% receiving RRT the UFNET intensity > 25 ml/kg/day is associated with a lower risk-adjusted 1-year mortality compared to those at lower intensities.


This article review was prepared and submitted by Ilona Bobek, PhD, Department of Anaesthesiology and Intensive Care Medicine, Dél-Pest Centrum Kórház-OHII, Budapest, Hungary on behalf of the ESICM AKI Section & Journal Review Club.


1) R. Murugan, V. Balakumar, S.J. Kerti, et al, Net ultrafiltration intensity and mortality in critically ill patients with fluid overload, Critical Care (2018) 22:223. doi: 10.1186/s13054018

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