Colloids and crystalloids: does it matter to the kidney?

To highlight some of the recent key issues surrounding crystalloid and colloid fluid management of critically ill patients.

Significant developments have been made in the understanding of ionic balance of fluids and their effects on acid-base, the role of hydration and overhydration, alkalinization of fluids in patients at high risk for contrast induced nephropathy, and finally the role of colloids in acute kidney injury.

Despite hydration remaining a key principle in fluid management in many patients, volume overload is of considerable concern. Recent evidence also suggests that balanced electrolyte formulations are preferable to saline-based formulations in a variety of clinical settings. Furthermore, alkalinization of fluids is protective in the setting of contrast-induced nephropathy. Oncotic load appears to be the most important factor in acute kidney injury associated with colloid fluid therapy.