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Are all fluids bad for the kidney?

Johan Mårtensson1, Rinaldo Bellomo

  • 1aDepartment of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia bSection of Anaesthesia and Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden cAustralian and New Zealand Intensive Care Research Centre, School of Preventive Medicine and Public Health, Monash University, Melbourne, Victoria, Australia.

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Intravenous fluids can harm kidneys, causing acute kidney injury. Avoid synthetic colloids and be cautious with chloride-rich solutions; albumin may benefit liver failure patients.

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Intravenous fluid administration is common in clinical practice.
  • Understanding fluid effects on kidney function is crucial for patient outcomes.

Purpose of the Study:

  • To detail the adverse renal effects of intravenous fluids.
  • To compare different fluid types regarding kidney outcomes.

Main Methods:

  • Review of current literature on intravenous fluid nephrotoxicity.
  • Analysis of comparative studies on fluid efficacy and safety.

Main Results:

  • Excessive fluids can cause kidney edema and impair renal blood flow.
  • Chloride-rich fluids may hinder renal autoregulation; synthetic colloids can cause osmotic nephrosis.
  • Albumin shows promise in liver failure but its superiority over crystalloids in sepsis is unproven.

Conclusions:

  • Synthetic colloids should be avoided in patients with compromised renal function.
  • Further trials are needed to confirm adverse effects of chloride-rich solutions.
  • Albumin is safe in sepsis and beneficial in liver failure patients.