Fluid management in acute kidney injury
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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.
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