Emma J de Louw1, Pepijn O Sun1, Joon Lee2, Mengling Feng3, Roger G Mark4, Leo Anthony Celi5, Kenneth J Mukamal1, John Danziger6. 1. Beth Israel Deaconess Medical Center, Department of Medicine. 2. Harvard-MIT Division of Health Sciences and Technology; School of Public Health and Health Systems, University of Waterloo. 3. Harvard-MIT Division of Health Sciences and Technology; Institute for Infocomm Research, A*STAR, Singapore. 4. Harvard-MIT Division of Health Sciences and Technology. 5. Beth Israel Deaconess Medical Center, Department of Medicine; Harvard-MIT Division of Health Sciences and Technology. 6. Beth Israel Deaconess Medical Center, Department of Medicine. Electronic address: jdanzige@bidmc.harvard.edu.
Abstract
OBJECTIVE: Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated. METHODS: In a large single-center cohort of critically ill patients, we evaluated whether admission body mass index was associated with the administration of either oral or intravenous diuretics during the intensive care unit (ICU) stay. MAIN RESULTS: Of 7724 critically ill patients, 3946 (51.1%) were prescribed diuretics during the ICU stay. Overweight, class I obesity, and class II/III obesity were associated with a 1.35 (95% confidence interval [CI], 1.20-1.53; P < .001), 1.56 (95% CI, 1.35-1.80; P < .001), and 1.91 (95% CI, 1.61-2.26; P < .001) adjusted risk of receiving diuretics within the ICU, respectively. In adjusted analysis, a 5-kg/m(2) increment of body mass index was associated with a 1.19 (95% CI, 1.14-1.23; P < .001) increased adjusted risk of within-ICU diuretics. Among those patients receiving loop diuretics, obese patients received significantly larger daily diuretic doses. CONCLUSION: Critically ill obese patients are more likely to receive diuretics during their stay in the ICU and to receive higher dosages of diuretics. Our data suggest that obesity is an independent risk factor for sodium retention.
OBJECTIVE:Sodium retention occurs commonly in cardiac and liver disease, requiring the administration of diuretics to restore fluid balance. Whether obesity is associated with sodium retention has not been fully evaluated. METHODS: In a large single-center cohort of critically ill patients, we evaluated whether admission body mass index was associated with the administration of either oral or intravenous diuretics during the intensive care unit (ICU) stay. MAIN RESULTS: Of 7724 critically ill patients, 3946 (51.1%) were prescribed diuretics during the ICU stay. Overweight, class I obesity, and class II/III obesity were associated with a 1.35 (95% confidence interval [CI], 1.20-1.53; P < .001), 1.56 (95% CI, 1.35-1.80; P < .001), and 1.91 (95% CI, 1.61-2.26; P < .001) adjusted risk of receiving diuretics within the ICU, respectively. In adjusted analysis, a 5-kg/m(2) increment of body mass index was associated with a 1.19 (95% CI, 1.14-1.23; P < .001) increased adjusted risk of within-ICU diuretics. Among those patients receiving loop diuretics, obesepatients received significantly larger daily diuretic doses. CONCLUSION:Critically ill obesepatients are more likely to receive diuretics during their stay in the ICU and to receive higher dosages of diuretics. Our data suggest that obesity is an independent risk factor for sodium retention.
Authors: Gregg C Fonarow; Preethi Srikanthan; Maria Rosa Costanzo; Guillermo B Cintron; Margarita Lopatin Journal: Am Heart J Date: 2007-01 Impact factor: 4.749
Authors: David T Selewski; Timothy T Cornell; Rebecca M Lombel; Neal B Blatt; Yong Y Han; Theresa Mottes; Mallika Kommareddi; David B Kershaw; Thomas P Shanley; Michael Heung Journal: Intensive Care Med Date: 2011-04-30 Impact factor: 17.440
Authors: F H Messerli; K Sundgaard-Riise; E D Reisin; G R Dreslinski; H O Ventura; W Oigman; E D Frohlich; F G Dunn Journal: Ann Intern Med Date: 1983-12 Impact factor: 25.391
Authors: Didier Payen; Anne Cornélie de Pont; Yasser Sakr; Claudia Spies; Konrad Reinhart; Jean Louis Vincent Journal: Crit Care Date: 2008-06-04 Impact factor: 9.097
Authors: Kenneth P Chen; Susan Cavender; Joon Lee; Mengling Feng; Roger G Mark; Leo Anthony Celi; Kenneth J Mukamal; John Danziger Journal: Clin J Am Soc Nephrol Date: 2016-01-19 Impact factor: 8.237
Authors: John Danziger; Ken P Chen; Joon Lee; Mengling Feng; Roger G Mark; Leo Anthony Celi; Kenneth J Mukamal Journal: Crit Care Med Date: 2016-02 Impact factor: 7.598
Authors: Leo Anthony Celi; Sharukh Lokhandwala; Robert Montgomery; Christopher Moses; Tristan Naumann; Tom Pollard; Daniel Spitz; Robert Stretch Journal: J Med Internet Res Date: 2016-08-24 Impact factor: 5.428