A Retrospective Analysis of Fluid Balance in Patients With AKI and Respiratory Failure due to COVID-19

ABSTRACT

Background: The optimal amount of hydration for patients with severe COVID-19 infection and AKI is unknown. This study aims to investigate the impact of fluid management strategy and outcomes in patients with AKI and respiratory failure due to COVID-19. Method(s) Data was gathered from a retrospective chart review of patients with hypoxia due to COVID-19 infection and stage 2 or greater AKI. Primary outcome was the difference in net fluid balance between patients who were successfully weaned to lower levels of oxygen support and discharged compared to those who died or remained ventilator dependent. Result(s) Of 58 cases, 41 died, 3 remained ventilator-dependent, and 14 were discharged without supplemental oxygen. The groups differed in net fluid balance (-10,065 cc vs +7,980 cc, p <0.001) and daily fluid balance (-367 vs. 515 cc/day, p <0.001) with a substantially lower mean fluid balance in patients who survived with minimal requirement for supplemental oxygen. Patients who maintained a positive fluid balance were significantly more likely to become ventilator dependent or die (OR 40.7, 95% CI 5.3 - 312.9). A fluid restrictive strategy did not reduce the likelihood of recovery from AKI or increase the need for renal replacement therapy. Conclusion(s) 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.