Does fluid management affect the occurrence of acute kidney injury?
OBJECTIVE
To describe the potential impact of different fluid management strategies on renal outcomes in critically ill and postoperative patients.


RESULTS
Uncritical fluid administration may induce renal compartment syndrome and renal venous congestion, which contribute to kidney dysfunction. In more than 5000 randomized surgical or septic patients, goal-directed therapy did not reduce fluid accumulation, acute kidney injury (AKI) development or need for renal replacement therapy. In contrast to synthetic colloids, which increase the risk of AKI, albumin solutions and balanced crystalloids appear well tolerated from a renal standpoint in medical and surgical patients requiring intensive care. However, any clinical benefits compared with 0.9% sodium chloride have not yet been demonstrated.


CONCLUSIONS
Although synthetic colloids should be avoided in patients with or at risk of AKI, the renal efficacy of using albumin solutions and/or balanced crystalloids as alternatives to 0.9% sodium chloride in high-risk patients is yet to be confirmed or refuted. Improved goal-directed protocols, which minimize unnecessary fluid administration and reduce potentially harmful effects of fluid overload, need to be developed and tested.
aDepartment of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia bDepartment of Anaesthesia and Intensive Care Medicine, Karolinska University Hospital, Solna cDepartment of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden dAustralian and New Zealand Intensive Care Research Centre, School of Preventive Medicine and Public Health, Monash University, Melbourne, Victoria, Australia.
Johan
J
Mårtensson
Rinaldo
R
Bellomo
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D003161:Compartment Syndromes / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D016638:Critical Illness; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017582:Renal Replacement Therapy / Q000379:methods; D013514:Surgical Procedures, Operative / Q000009:adverse effects*