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Title: Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.
Austin Authors: Vaara, Suvi T;Ostermann, Marlies;Bitker, Laurent;Schneider, Antoine;Poli, Elettra;Hoste, Eric;Fierens, Jan;Joannidis, Michael;Zarbock, Alexander;van Haren, Frank;Prowle, John;Selander, Tuomas;Bäcklund, Minna;Pettilä, Ville;Bellomo, Rinaldo 
Affiliation: Centre for Integrated Critical Care, School of Medicine, The University of Melbourne, Melbourne, Australia
Critical Care and Preoperative Medicine Research Group, Centre for Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK
Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
Intensive Care
CREATIS CNRS UMR5220 INSERM U1044 INSA-Lyon, Université de Lyon, Lyon, France..
Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Intensive Care Unit M1, Meilahti Hospital, Box 340, 00290, Helsinki, Finland..
Australian National University Medical School, Canberra, Australia
Intensive Care Unit, Canberra Hospital, Canberra, Australia
Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland..
Intensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium..
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria..
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany..
Science Service Center, Kuopio University Hospital, Kuopio, Finland..
Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland..
Issue Date: 7-May-2021 2021
Publication information: Intensive Care Medicine 2021; online first: 7 May
Abstract: We compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation. This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization. Mean (SD) cumulative fluid balance at 72 h from randomization was - 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) - 1148 mL (- 2200 to - 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference - 1.0 [- 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm. In critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified.
DOI: 10.1007/s00134-021-06401-6
ORCID: 0000-0002-6851-3828
PubMed URL: 33961058
Type: Journal Article
Subjects: Acute kidney injury
Critically ill
Fluid balance
Restrictive fluid management
Appears in Collections:Journal articles

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