title: Perioperative fluid balance and acute kidney injury.
abstract: BACKGROUND
  Positive fluid balance (FB) has been linked to adverse clinical outcomes. We performed this study to explore the relationship between perioperative fluid balance and acute kidney injury (AKI).
  
  
  METHODS
  The relationships between FB and AKI were explored using a prospective, observational design. Patients were divided into quartiles based on FB status in the first 24 h from initiation of surgery in order to further explore this relationship.
  
  
  RESULTS
  One hundred adult patients undergoing cardiovascular surgery were included in the analysis. The major finding of the study was that positive FB occurred early in the intraoperative period and progressed into the postoperative period and that fluid administration was not clearly associated with any identifiable volume-sensitive event. The evolution of positive FB preceded the rise in serum creatinine. Progressive severity of positive FB was associated with increased incidence of AKI. The highest quartile FB group had a five-fold increased risk for AKI (adjusted odds ratio 4.98, 95 % confidence interval 1.38-24.10, p = 0.046) compared to the lowest quartile group, higher postoperative peak serum creatinine values (p < 0.001), surgery-related complications (p < 0.001) and intensive care unit (p < 0.001) and hospital length of stay (p = 0.048).
  
  
  CONCLUSIONS
  Positive FB was associated with increased incidence of AKI.
authors.affiliation: Division of Nephrology, Hypertension and Transplantation, University of Florida, PO Box 100224, Gainesville, FL 32610-0224, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Kambhampati
authors.forename: Edward A
authors.initials: EA
authors.lastname: Ross
authors.forename: Mourad M
authors.initials: MM
authors.lastname: Alsabbagh
authors.forename: Abdo
authors.initials: A
authors.lastname: Asmar
authors.forename: Uma
authors.initials: U
authors.lastname: Pakkivenkata
authors.forename: Noel I
authors.initials: NI
authors.lastname: Ejaz
authors.forename: Amir A
authors.initials: AA
authors.lastname: Arif
authors.forename: A Ahsan
authors.initials: AA
authors.lastname: Ejaz
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014882:Water-Electrolyte Balance
chemical_list: D003404:Creatinine