Please use this identifier to cite or link to this item:
Title: Fluid balance and acute kidney injury.
Austin Authors: Prowle, John R;Echeverri, Jorge E;Ligabo, E Valentina;Ronco, Claudio;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, 145 Studley Road Heidelberg, Vic 3084, Australia
Issue Date: 22-Dec-2009
Publication information: Nature Reviews. Nephrology 2009; 6(2): 107-15
Abstract: Intravenous fluids are widely administered to patients who have, or are at risk of, acute kidney injury (AKI). However, deleterious consequences of overzealous fluid therapy are increasingly being recognized. Salt and water overload can predispose to organ dysfunction, impaired wound healing and nosocomial infection, particularly in patients with AKI, in whom fluid challenges are frequent and excretion is impaired. In this Review article, we discuss how interstitial edema can further delay renal recovery and why conservative fluid strategies are now being advocated. Applying these strategies in critical illness is challenging. Although volume resuscitation is needed to restore cardiac output, it often leads to tissue edema, thereby contributing to ongoing organ dysfunction. Conservative strategies of fluid management mandate a switch towards neutral balance and then negative balance once hemodynamic stabilization is achieved. In patients with AKI, this strategy might require renal replacement therapy to be given earlier than when more-liberal fluid management is used. However, hypovolemia and renal hypoperfusion can occur in patients with AKI if excessive fluid removal is pursued with diuretics or extracorporeal therapy. Thus, accurate assessment of fluid status and careful definition of targets are needed at all stages to improve clinical outcomes. A conservative strategy of fluid management was recently tested and found to be effective in a large, randomized, controlled trial in patients with acute lung injury. Similar randomized, controlled studies in patients with AKI now seem justified.
Gov't Doc #: 20027192
DOI: 10.1038/nrneph.2009.213
Journal: Nature reviews. Nephrology
Type: Journal Article
Subjects: Acute Kidney Injury.therapy
Fluid Therapy.adverse effects
Practice Guidelines as Topic
Appears in Collections:Journal articles

Show full item record

Page view(s)

checked on Apr 19, 2024

Google ScholarTM


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.