P393 - HIGHER BMI IN ICU PATIENTS IS ASSOCIATED WITH INCREASED SERUM CREATININE AND MORE FREQUENT RENAL REPLACEMENT THERAPY

P393

HIGHER BMI IN ICU PATIENTS IS ASSOCIATED WITH INCREASED SERUM CREATININE AND MORE FREQUENT RENAL REPLACEMENT THERAPY

A. Fischer^1,*, A. Schartmann², S. Tarantino², C. Schuh³, M. Hiesmayr²

¹Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care, ²Center for Medical Data Science, ³IT Systems and Communications, Medical University of Vienna, Vienna, Austria

Rationale: Higher BMI has been associated with improved creatinine clearance. ICU patients that need renal replacement therapy (CRRT) have an increased hospital mortality. We investigated if a beneficial effect of BMI on serum creatinine and need for CRRT is observed in the nutritionDay ICU patients. 

Methods: 22544 adult ICU patients from the nutritionDay database 2007-2023 were analysed with linear and logistic regression (STATA 15.1) adjusted for age, sex, severity at admission and organ dysfunction. Data are shown as estimates with 95% CI or median with quantiles.

Results: 22544 adult patients with age 64 [51;74], 41% women from 1841 ICUs in 64 countries were included. ICU stay at nutritionDay was median 4[1-13], BMI 25.6 [22.7;29.3], creatinine on the admission day 1.00 [0.74;1.6] mg/dL and 0.93 [0.66;1.5] on nutritionDay. CRRT was used in 2201/20262(9.8%) patients. Patients with CRRT on nutritionDay had a doubled mortality (45% vs 22%) compared with those without CRRT.

In the multivariate model increasing BMI was associated with a more than 20% increase in creatinine on admission and on nutritionDay (P<0.0001) (Figure 1). A higher urinary volume with higher BMI was observed on nutritionDay. Rate of CRRT increased with BMI and was highest for BMI 30-35 with an OR of 1.27 [1.09;1.46] and for BMI 35-40 with an OR of 1.32 [1.07;1.62]. Patients with BMI 25-35 had a lower mortality than patients with normal BMI.

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Conclusion: Higher BMI was associated with higher creatinine values, higher urine volume and a 25% increase in the CRRT rate. Higher BMI is associated with better outcome despite the increased CRRT rate. Whether higher muscle mass in obese patients is the driver for increased creatinine needs to be investigated.

References:         1. Sinkeler SJ et al Nephrol Dial Transplant 2011 Oct;26(10):3181-8

        2. Gerchmann F et al J Clin Endocrinol Metab. 2009 Jul 7;94(10):3781–3788

Disclosure of Interest: None declared