title: Fluid overload and acute kidney injury: cause or consequence?
abstract: There is increasing evidence that fluid overload and acute kidney injury (AKI) are associated but the exact cause-effect relationship remains unclear. Wang and colleagues analysed patients admitted to 30 intensive care units in China and found that fluid accumulation was independently associated with an increased risk of AKI and mortality. This commentary focuses on the close pathophysiological link between AKI and fluid overload and discusses the implications for clinical practice. It outlines some of the challenges, including the difficulty in diagnosing fluid overload reliably with current methods, and stresses the importance of personalised fluid therapy with physiological end-points to avoid the deleterious effects of fluid overload.
authors.affiliation: Department of Critical Care and Nephrology, King's College London, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. marlies.ostermann@gstt.nhs.uk.
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
authors.affiliation: Department of Adult Intensive Care, VU University Medical Centre, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
authors.forename: Heleen M Oudemans-van
authors.initials: HM
authors.lastname: Straaten
authors.affiliation: Surrey Perioperative Anaesthesia & Critical Care Collaborative Research Group Royal Surrey County Hospital NHS Foundation Trust & School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.|Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, UK.
authors.forename: Lui G
authors.initials: LG
authors.lastname: Forni
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000209:etiology* / Q000401:mortality; D001826:Body Fluids / Q000378:metabolism*; D002681:China; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D014882:Water-Electrolyte Balance / Q000502:physiology*