Fluid therapy and acute kidney injury: a question of balance?

Fluid therapy remains one of the funda-mental treatment options available for pa-tients with acute kidney injury. However, there remains debate over several aspects of this treatment with many questions unanswered. Firstly, how do we prescribe fluid in this group of patients? Secondly, what is the role of fluid therapy in patients with or at risk of developing acute kidney injury and thirdly, what role does fluid balance play, if any, in the development of acute kidney injury. The following narra-tive review will attempt to tie some of the aspects of the treatment of this devastat-ing syndrome together and formulate an overall hypothesis for fluid management in acute kidney injury.

Acute kidney injury, glomerular filtration rate, fluid overload 

1. Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive care medicine. 2015;41(8):1411-1423.

2. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1-138.

3. Payen D. Back to basic physiological questions and consideration of fluids as drugs. British journal of anaesthesia. 2014;113(5):732-733.

4. Prowle JR, Bellomo R. Fluid administration and the kidney. Current opinion in critical care. 2010;16(4):332-336.

5. Mitchell JP, Schuller D, Calandrino FS, Schuster DP. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. The American review of respiratory disease. 1992;145(5):990-998.

6. National Heart L, Blood Institute Acute Respiratory Distress Syndrome Clinical Trials N, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, et al. Comparison of two fluid-management strategies in acute lung injury. The New England journal of medicine. 2006;354(24):2564-2575.

7. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. The New England journal of medicine. 2001;345(19):1368-1377.

8. Padhi S, Bullock I, Li L, Stroud M, National Institute for H, Care Excellence Guideline Development G. Intravenous fluid therapy for adults in hospital: summary of NICE guidance. Bmj. 2013;347:f7073.

9. Vincent JL, De Backer D. Circulatory shock. The New England journal of medicine. 2013;369(18):1726-1734.

10. Myburgh JA, Mythen MG. Resuscitation fluids. The New England journal of medicine. 2013;369(13):1243-1251.