Abstract:

Objective

To explore the role of non-invasive assessment in fluid volume management of patients with acute kidney injury （AKI） treated with continuous renal replacement therapy （CRRT） by combining the ultrasonic cardiac output monitor （USCOM） and the body composition monitor （BCM）.

Methods

This study adopted a single-center， randomized， parallel-controlled method. Patients with AKI who underwent CRRT in the intensive care unit of the Department of Nephrology， First Medical Center of Chinese PLA General Hospital from April 2022 to October 2023 were included. The patients were divided into a control group and a test group according to the volume assessment methods. In the control group，traditional parameters such as central venous pressure and blood pressure were used to guide fluid volume management， while in the test group， non-invasive assessment with the ultrasonic cardiac output monitor combined with the body composition monitor was used to guide fluid volume management. The clinical baseline characteristics， hemodynamic parameters， incidence of complications， and hospital outcomes of the two groups of patients before and after CRRT were compared.

Results

A total of 50 patients were included，with 25 patients in each group. There were no statistically significant differences in baseline characteristics such as age， gender， etiology of AKI， underlying diseases， severity scores， and laboratory examinations between the two groups （all P＞0.05）. Compared with the control group， the test group after CRRT showed higher levels in the mean arterial pressure， stroke volume， and extracellular water （all P＜0.05）， but lower levels in the incidences of complications such as heart failure， hypotension， and muscle spasm， the total number of hospitalization days， the number of ICU hospitalization days， the total treatment time of CRRT，and the in-hospital mortality rate （all P＜0.05）.

Conclusion

For patients with AKI undergoing CRRT， the combination of the USCOM and the BCM could quickly and non-invasively assess the fluid volume overload，guide the prescription dosage of CRRT， achieving the precise volume management.

Key words: Acute kidney injury, Continuous renal replacement therapy, Non-invasive assessment, Volume management