Outcomes of end‐stage renal disease patients in the PROCESS trial

Abstract

Abstract Objective Intravenous fluid administration is a main component of sepsis therapy, but physicians are cautious about giving fluids to end‐stage renal disease (ESRD) patients out of concern for causing volume overload. We compared the outcomes of septic shock patients with and without ESRD and evaluated the association between early intravenous fluid administration and outcomes. Methods We analyzed patients enrolled in the Protocolized Care for Early Septic Shock (PROCESS) trial, which studied different resuscitation strategies for early septic shock. Stratifying for ESRD, we compared patient characteristics, course of care, and outcomes between ESRD and non‐ESRD. Using multivariable logistic regression, we determined the association between 6‐hour total fluid volume (> = 30 mL/kg vs = 30 mL/kg (66.6% vs 86.7% P = 30 mL/kg intravenous fluid did not alter any outcome. For non‐ESRD patients, receiving ≥30 mL/kg of intravenous fluid was associated with increased 90‐day mortality (adjusted odds ratio = 1.64; 95% confidence interval, 1.03‐2.61). Conclusions In the PROCESS trial, ESRD patients had similar outcomes to non‐ESRD patients. Although ESRD patients received less intravenous fluid administration, most received over 30 mL/kg in the first 6 hours. In contrast to non‐ESRD patients, receiving ≥30 mL/kg of intravenous fluid was not associated with worse outcomes in ESRD.

Keywords

• critical care
• ESRD
• kidney disease
• resuscitation
• sepsis
• septic shock