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Fluid overload and acute kidney injury: cause or consequence?
Marlies Ostermann1, Heleen M Oudemans-van Straaten2, Lui G Forni3,4
1Department of Critical Care and Nephrology, King's College London, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK. marlies.ostermann@gstt.nhs.uk.
Critical Care (London, England)
|December 29, 2015
Summary
Fluid overload is linked to a higher risk of acute kidney injury (AKI) and death. Personalized fluid therapy is crucial to prevent negative outcomes from fluid accumulation.
Area of Science:
- Nephrology
- Critical Care Medicine
- Fluid Balance Management
Background:
- Increasing evidence suggests a link between fluid overload and acute kidney injury (AKI).
- The precise cause-effect relationship between fluid overload and AKI remains incompletely understood.
- Fluid accumulation is a common complication in intensive care unit (ICU) settings.
Purpose of the Study:
- To examine the association between fluid accumulation and the risk of AKI and mortality in ICU patients.
- To discuss the pathophysiological relationship between AKI and fluid overload.
- To highlight clinical practice implications and challenges in fluid management.
Main Methods:
- Analysis of patient data from 30 intensive care units in China.
- Investigated the independent association of fluid accumulation with AKI and mortality.
- Commentary on existing evidence and clinical practice.
Main Results:
- Fluid accumulation was independently associated with an increased risk of AKI.
- Fluid accumulation was also independently associated with an increased risk of mortality.
- Challenges in reliably diagnosing fluid overload with current methods were identified.
Conclusions:
- A close pathophysiological link exists between AKI and fluid overload.
- Personalized fluid therapy guided by physiological end-points is essential.
- Avoiding the detrimental effects of fluid overload is critical for patient outcomes.
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