Fluid management in acute kidney injury
- 4.8k Downloads
Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI.
KeywordsAcute kidney injury Critical Care Fluid Intravenous fluid Kidney failure Renal failure Sepsis Shock
Compliance with ethical standards
Conflicts of interest
AP is member of the steering committee and national investigator of a vasopressin trial in septic shock sponsored by Ferring Pharmaceuticals; his department is reimbursed for his time. The department also receives research funding from Fresenius Kabi and CSL Behring. MJ is a consultant or speaker for Baxter, Fresenius, Asahi Kasei, Astute, CSL Behring. PY is a member of the Plasmalyte vs. Saline (PLUS) trial management committee. Baxter Healthcare is providing fluids for this trial.
- 4.Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf. Accessed 1 Jan 2017.
- 19.Nijssen EC, Rennenberg RJ, Nelemans PJ et al (2017) Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. doi: 10.1016/S0140-6736(17)30057-0 PubMedGoogle Scholar
- 25.Zarychanski R, Abou-Setta AM, Turgeon AF et al (2013) Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA 309:678–688. doi: 10.1001/jama.2013.430 CrossRefPubMedGoogle Scholar
- 30.FDA (2013) FDA Safety Communication: Boxed Warning on increased mortality and severe renal injury, and additional warning on risk of bleeding, for use of hydroxyethyl starch solutions in some settings. https://www.fda.gov/downloads/biologicsbloodvaccines/bloodbloodproducts/approvedproducts/newdrugapplicationsndas/ucm083138.pdf. Accessed 1 Jan 2017.
- 31.EMA (2013) Hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Hydroxyethyl_starch-containing_solutions/human_referral_prac_000012.jsp&mid=WC0b01ac05805c516f. Accessed 1 Jan 2017.
- 33.Bayer O, Reinhart K, Kohl M et al (2012) Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis. Crit Care Med 40:2543–2551. doi: 10.1097/CCM.0b013e318258fee7 CrossRefPubMedGoogle Scholar
- 39.Chowdhury AH, Cox EF, Francis ST, Lobo DN (2012) A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and Plasma-Lyte® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 256:18–24. doi: 10.1097/SLA.0b013e318256be72 CrossRefPubMedGoogle Scholar
- 58.Hjortrup PB, Haase N, Bundgaard H et al (2016) Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med 42:1695–1705. doi: 10.1007/s00134-016-4500-7 CrossRefPubMedGoogle Scholar
- 59.Silversides JA, Major E, Ferguson AJ et al (2016) Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. doi: 10.1007/s00134-016-4573-3 PubMedGoogle Scholar
- 62.Vaara ST, Korhonen A-M, Kaukonen K-M et al (2012) Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. Crit Care 16:R197. doi: 10.1186/cc11682 CrossRefPubMedPubMedCentralGoogle Scholar
- 71.Chen H, Wu B, Gong D, Liu Z (2015) Fluid overload at start of continuous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combined use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement. Crit Care 19:135. doi: 10.1186/s13054-015-0871-3 CrossRefPubMedPubMedCentralGoogle Scholar
- 73.Mikkelsen ME, Christie JD, Lanken PN et al (2012) The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med 185:1307–1315. doi: 10.1164/rccm.201111-2025OC CrossRefPubMedPubMedCentralGoogle Scholar
- 77.Guidet B, Martinet O, Boulain T, Philippart F, Poussel J, Maizel J, Forceville X, Feissel M, Hasselmann M, Heininger A, Aken HV (2012) Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Critical Care 16(3):R94CrossRefPubMedPubMedCentralGoogle Scholar