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Fluid administration and the kidney

Prowle, John R.a; Bellomo, Rinaldob

Current Opinion in Critical Care:
doi: 10.1097/MCC.0b013e3283632e29
INTRAVENOUS FLUIDS: Edited by John Myburgh
Abstract

Purpose of review: To review recent studies and information on the relationship between fluid administration and kidney function in critically ill patients.

Recent findings: There is little evidence from large multicenter trials to direct fluid therapy in patients at risk of acute kidney injury (AKI). Evidence of benefit for fluid administration from single center studies of fluid resuscitation to hemodynamic goals needs to be weighed against evidence of harm associated with fluid overload in large observational studies. The composition of intravenous fluid may affect the risk of AKI. Even latest-generation hydroxyethyl starches increase the risk of severe AKI in general and septic ICU patients. Isotonic saline has been associated with greater incidence of AKI in comparison to buffered crystalloids. Experimentally, infusion of saline results in reduction in renal perfusion in comparison to buffered solutions.

Summary: Clinicians need to weigh the balance between adequate resuscitation of cardiac output and avoidance of fluid overload. Protocolized resuscitation to hemodynamic goals may help achieve these conflicting goals at least in the early phases of critical illness. In critically ill patients with, or at risk of, AKI, clinicians should avoid starch and, possibly, saline solutions.

Author Information

aAdult Critical Care Unit and Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK

bDepartment of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia

Correspondence to Professor Rinaldo Bellomo, MD, FRACP, FCICM, Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia. Tel: +61 3 94965992; fax: +61 3 94963932; e-mail: rinaldo.bellomo@monash.edu;rinaldo.bellomo@austin.org.au

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins