Fluid Management in Acute Kidney Injury

TY - JOUR

T1 - Fluid Management in Acute Kidney Injury

AU - Ostermann, Marlies

AU - Liu, Kathleen

AU - Kashani, Kianoush

PY - 2019/4/16

Y1 - 2019/4/16

N2 - Correction of intravascular hypovolemia is a key component of the prevention and management of acute kidney injury (AKI), but excessive fluid administration is associated with poor outcomes, including the development and progression of AKI. There is growing evidence that fluid administration should be individualized and take into account patient characteristics, nature of the acute illness and trajectories, and risks and benefits of fluids. Existing data support the preferential use of buffered solutions for fluid resuscitation of patients at risk of AKI who do not have hypochloremia. There is a limited role for albumin, and starches should be avoided. Fluids should only be administered until intravascular hypovolemia has been corrected and euvolemia has been achieved using the minimum amount of fluid required to achieve and maintain euvolemia. Oliguria alone should not be viewed as a trigger for fluid administration. If fluid overload occurs, fluid therapy needs to be discontinued, and fluid removal using diuretic agents or extracorporeal therapies should be considered.

AB - Correction of intravascular hypovolemia is a key component of the prevention and management of acute kidney injury (AKI), but excessive fluid administration is associated with poor outcomes, including the development and progression of AKI. There is growing evidence that fluid administration should be individualized and take into account patient characteristics, nature of the acute illness and trajectories, and risks and benefits of fluids. Existing data support the preferential use of buffered solutions for fluid resuscitation of patients at risk of AKI who do not have hypochloremia. There is a limited role for albumin, and starches should be avoided. Fluids should only be administered until intravascular hypovolemia has been corrected and euvolemia has been achieved using the minimum amount of fluid required to achieve and maintain euvolemia. Oliguria alone should not be viewed as a trigger for fluid administration. If fluid overload occurs, fluid therapy needs to be discontinued, and fluid removal using diuretic agents or extracorporeal therapies should be considered.

KW - acute kidney injury

KW - colloids

KW - crystalloids

KW - fluid therapy

KW - fluids

UR - http://www.scopus.com/inward/record.url?scp=85067356754&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2019.04.004

DO - 10.1016/j.chest.2019.04.004

M3 - Review article

C2 - 31002784

AN - SCOPUS:85067356754

SN - 0012-3692

VL - 156

SP - 594

EP - 603

JO - Chest

JF - Chest

IS - 3

ER -