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1、FluidBalance,DiureticUse,andMortalityinAcuteKidneyInjuryMorganE.Grams,*†MichelleM.Estrella,*JosefCoresh,*†‡,RoyG.Brower,*andKathleenD.Liu§fortheNationalHeart,Lung,andBloodInstituteAcuteRespiratoryDistressSyndromeNetworkClinJAmSocNephrol6:966–973,2011.FACTTBackgroundandobj
2、ectivesManagementofvolumestatusinpatientswithacutekidneyinjury(AKI)iscomplex,andtheroleofdiureticsiscontroversial.Theprimaryobjectivewastoelucidatetheassociationbetweenfluidbalance,diureticuse,andshort-termmortalityafterAKIincriticallyillpatients.Optimalfluidmanagementina
3、cutekidneyinjury(AKI)iscontroversial.Traditionally,aggressivefluidresuscitationhasbeenprescribedinAKItoavoidadditionalprerenalorhemodynamicinsultsduringongoingrenaldysfunctionMorerecently,however,observationalstudieshavedemonstratedanassociationbetweenapositivefluidbalanc
4、e,renalnonrecovery,andmortalityinchildrenandadultswithAKI.Design,setting,participants,&measurementsUsingdatafromtheFluidandCatheterTreatmentTrial(FACTT),amulticenter,randomizedcontrolledtrialevaluatingaconservativeversusliberalfluid-managementstrategyin1000patientswithacu
5、telunginjury(ALI),weevaluatedtheassociationofpost-renalinjuryfluidbalanceanddiureticusewith60-daymortalityinpatientswhodevelopedAKI,asdefinedbytheAKINetworkcriteria.TheFluidandCatheterTreatmentTrial(FACTT)wasthelargestandonlymulticentertrialofafluid-restrictivemanagements
6、trategyforthetreatmentofacutelunginjury(ALI).Althoughtherewasnodemonstratedmortalitybenefit,thefluid-restrictivemanagementstrategywasassociatedwithanincreasednumberofventilator-freedaysandatrendtowardareducedrequirementforrenalreplacementtherapy.Results306patientsdevelope
7、dAKIinthefirst2studydaysandwereincludedinouranalysis.Therewere137inthefluid-liberalarmand169inthefluid-conservativearm(P0.04).Baselinecharacteristicsweresimilarbetweengroups.Post-AKIfluidbalancewassignificantlyassociatedwithmortalityinbothcrudeandadjustedanalysis.Higherpo
8、st-AKIfurosemidedoseshadaprotectiveeffectonmortalitybutnosignificanteffectafteradjustmentforpost
