Pharmacologic approaches for volume excess in acute kidney injury (AKI).
Volume management is an integral component of the care of patients with acute kidney injury (AKI). Considerable controversy exists regarding the use of pharmacological agents for volume management. Although overt fluid overload is often seen in AKI and may prompt attention for the use of diuretics, often these agents are used in the absence of fluid retention. Over the last decade several new agents have become available for volume removal. We reviewed the literature on this topic and addressed four key questions for the appropriate utilization of these agents. These include the drug targets and mechanism of action of available agents; clinical goals and criteria for timing of intervention; adaptation of therapy for specific clinical settings and measures required for monitoring effectiveness and patient safety. This report details our current knowledge in this area, provides evidence-based clinical practice recommendations where appropriate, and formulates a research agenda to address unanswered questions.
Mehta
R L
RL
Division of Nephrology, University of California San Diego, San Diego, CA 92103, USA. rmehta@ucsd.edu
Cantarovich
F
F
Shaw
A
A
Hoste
E
E
Murray
P
P
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy; D001201:Ascites / Q000188:drug therapy; D002034:Bumetanide / Q000008:administration & dosage / Q000627:therapeutic use; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005440:Fluid Therapy; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006530:Hepatorenal Syndrome / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000150:complications; D045283:Natriuretic Agents / Q000009:adverse effects / Q000627:therapeutic use; D009404:Nephrotic Syndrome / Q000503:physiopathology; D017582:Renal Replacement Therapy; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use; D000077786:Torsemide; D014462:Ultrafiltration; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy*
D004232:Diuretics; D045283:Natriuretic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D013449:Sulfonamides; D002034:Bumetanide; D005665:Furosemide; D000077786:Torsemide