Achievement of fluid removal targets during intermittent renal replacement therapy in the intensive care unit
Bibliographic record
Abstract
ABSTRACT Background In patients with acute kidney injury (AKI), fluid balance management often relies on the prescription and achievement of fluid removal using intermittent renal replacement therapy (IRRT). This study aimed to describe characteristics associated with the failure to achieve target fluid removal (FATFR). Methods This is a retrospective cohort study including IRRT sessions of conventional duration (<5 hours) performed for AKI in the intensive care unit (ICU) from 2017 to 2022 at a tertiary academic center. FATFR-50% was defined as fluid removal of <50% of the prescribed target. Characteristics of patients and sessions, as well as outcomes at 90 days were collected. The causes of FATFR were manually adjudicated. Results A total of 291 patients and 1280 IRRT sessions in the ICU were included. FATFR-50% occurred in 7.3% of sessions and 19.2% of patients had at least one session with FATFR-50% during the first week of IRRT. Sessions with FATFR-50% were characterized by a higher occurrence of intradialytic hypotension (24.2% vs 60.2%, P < .001) and a higher planned fluid removal (6.19 vs 5.27 m/kg/h, P = .02). Multiple episodes of FATFR-50% were associated with a positive cumulative fluid balance (β 3876 (CI 2053–5899) P < .001). At 90-day follow-up, FATFR-50% during the first week after IRRT initiation was independently associated with fewer ICU- and hospital-free days, as well as with a higher risk of mortality (odds ratio 2.01 CI 1.04–3.89, P = .04). Conclusions FATFR occurs in about one out of five critically ill patients within the first week of IRRT and is associated with adverse clinical outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".