Fluid management for the prevention and attenuation of acute kidney injury

John Prowle, Christopher John Kirwan, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

139 Citations (Scopus)

Abstract

In patients with acute kidney injury (AKI), optimization of systemic haemodynamics is central to the clinical management. However, considerable debate exists regarding the efficacy, nature, extent and duration of fluid resuscitation, particularly when the patient has undergone major surgery or is in septic shock. Crucially, volume resuscitation might be required to maintain or restore cardiac output. However, resultant fluid accumulation and tissue oedema can substantially contribute to ongoing organ dysfunction and, particularly in patients developing AKI, serious clinical consequences. In this Review, we discuss the conflict between the desire to achieve adequate resuscitation of shock and the need to mitigate the harmful effects of fluid overload. In patients with AKI, limiting and resolving fluid overload might prompt earlier use of renal replacement therapy. However, rapid or early excessive fluid removal with diuretics or extracorporeal therapy might lead to hypovolaemia and recurrent renal injury. Optimal management might involve a period of guided fluid resuscitation, followed by management of an even fluid balance and, finally, an appropriate rate of fluid removal. To obtain best clinical outcomes, serial fluid status assessment and careful definition of cardiovascular and renal targets will be required during fluid resuscitation and removal.
Original languageEnglish
Pages (from-to)37 - 47
Number of pages11
JournalNature Reviews Nephrology
Volume10
Issue number1
DOIs
Publication statusPublished - 2014

Cite this

Prowle, John ; Kirwan, Christopher John ; Bellomo, Rinaldo. / Fluid management for the prevention and attenuation of acute kidney injury. In: Nature Reviews Nephrology. 2014 ; Vol. 10, No. 1. pp. 37 - 47.
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Fluid management for the prevention and attenuation of acute kidney injury. / Prowle, John; Kirwan, Christopher John; Bellomo, Rinaldo.

In: Nature Reviews Nephrology, Vol. 10, No. 1, 2014, p. 37 - 47.

Research output: Contribution to journalArticleResearchpeer-review

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