Fluid management in acute kidney injury.
Chest. 2019 Apr 16;:
Authors: Ostermann M, Liu K, Kashani K
Correction of intravascular hypovolaemia 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 individualised 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 hypochloraemia. There is a limited role for albumin, and starches should be avoided. Fluids should only be administered until intravascular hypovolaemia has been corrected and euvolaemia has been achieved using the minimum amount of fluid required to achieve and maintain euvolaemia. 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 diuretics or extracorporeal therapies should be considered.
PMID: 31002784 [PubMed - as supplied by publisher]