title: [Hyperhydration and dialysis in acute kidney failure].
abstract: Despite the advances in critical care medicine, the hospital mortality in patients with acute kidney injury (AKI) requiring dialysis remains high. Depending on the underlying disease the in-house mortality is reported to be up to 80%. Several observational studies demonstrated an association between mortality and fluid overload. A primary mechanism of interest is that fluid overload causes tissue edema and subsequent reduction of perfusion, oxygenation and nutrient delivery. This results in further renal damage. In addition, fluid overload-related dilution within the extracellular space causes artificially low serum creatinine, which masks AKI diagnosis. As a consequence, renal protective management strategies are deferred, which further aggravates kidney injury. This aggravation of renal damage subsequently increases the mortality. This review discusses the role of fluid overload for outcomes in critically ill patients as described in the current literature and assesses criteria for the initiation of renal replacement therapy in this critically ill population.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen.
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.affiliation: Klinik für Nephrologie, Universitätsklinikum Essen.
authors.forename: Anja
authors.initials: A
authors.lastname: Bienholz
authors.affiliation: Klinik für Nephrologie, Universitätsklinikum Essen.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Tyczynski
authors.affiliation: Klinik für Nephrologie, Universitätsklinikum Essen.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.affiliation: Klinik für Nieren- und Hochdruckkrankheiten, Universitätsklinikum Kiel.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Feldkamp
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality* / Q000517:prevention & control*; D015984:Causality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D014869:Water Intoxication / Q000401:mortality* / Q000517:prevention & control*