• Xin Chen, Jiarui Xu, Yang Li, Bo Shen, Wuhua Jiang, Zhe Luo, Chunsheng Wang, Jie Teng, Xiaoqiang Ding, and Wenlv Lv.
• Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Shanghai Institute of Kidney Disease and Dialysis, Shanghai Laboratory of Kidney Disease and Dialysis, Shanghai Medical Center of Kidney Disease, Shanghai, People's Republic of China.
• J. Cardiothorac. Vasc. Anesth. 2021 Sep 1; 35 (9): 2700-2706.

ObjectivesIn addition to the association between positive fluid balance (FB) and acute kidney injury (AKI) after cardiac surgery reported by former studies, this study examined the relationship between FB and progressive AKI.DesignA retrospective, observational study.SettingUniversity teaching, grade A tertiary hospital in Shanghai, China.ParticipantsAdult patients after cardiac surgery from July-December 2016.InterventionsPerioperative data relating to postoperative fluid intake and output were collected. AKI progression was defined as a worsening of AKI stage. FB was calculated as (fluid intake [L] - fluid output [L]/body weight [kg] × 100%).Measurements And Main ResultsThe study comprised 1,522 patients. The incidences of AKI and progressive AKI were 33.1% (n = 504) and 18.1% (n = 91), respectively. There was an exponential increase between 24-hour FB and AKI occurrence, and an approximate "U"-shape association between 48-hour FB and AKI progression. Multivariate logistic regression showed that 24-hour FB ≥5% was an independent risk factor for AKI incidence (odds ratio [OR] 3.976; p < 0.001) and 48-hour FB <-5% or ≥3% was associated with an increase of AKI progression (FB <-5%, OR 7.078 [p = 0.031]; FB 3%-5%, OR 6.598 [p = 0.020]; FB ≥5%, OR 16.453 [p < 0.001]).ConclusionsAn exponential increase was found between 24-hour FB and AKI occurrence and a "U"-shape association between 48-hour FB and AKI progression. Both excessively negative and positive accumulative 48-hour FB increased the risk of AKI progression, suggesting cautious monitoring and application of fluid load in clinical practice.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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