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Fluid composition and acute kidney injury.

Fernando G Zampieri1, Alexandre B Libório, Alexandre B Cavalcanti

  • 1aResearch Institute, HCor-Hospital do Coração bIntensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo cPrograma de Pós-graduação em Ciência Médicas da Faculdade de Medicina da Universidade Federal do Ceará, Ceará dPrograma de Pós-graduação em Ciências Médicas da Universidade de Fortaleza - UNIFOR, Ceará, Brazil.

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Summary

Fluid composition impacts kidney outcomes in critically ill patients. While balanced solutions may benefit high-risk individuals, further research is needed to confirm their effectiveness and cost-efficiency.

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Area of Science:

  • Nephrology
  • Intensive Care Medicine
  • Critical Care

Background:

  • The role of fluid composition in renal outcomes for critically ill patients is under renewed investigation.
  • Observational studies suggest low-chloride, balanced solutions may reduce acute kidney injury (AKI).

Purpose of the Study:

  • To review recent advancements in understanding how fluid composition affects kidney outcomes in critically ill patients.

Main Methods:

  • Review of recent observational studies and a cluster randomized trial on fluid composition and renal outcomes.
  • Analysis of factors potentially influencing the association between fluid composition and AKI.

Main Results:

  • A recent cluster randomized trial did not demonstrate a benefit of balanced solutions, possibly due to low patient illness severity and fluid administration volumes.
  • The potential benefit of balanced solutions may be confined to high-risk, aggressively resuscitated patients.
  • The link between unbalanced solutions, hyperchloremia, and AKI requires further elucidation.

Conclusions:

  • Crystalloid fluid composition is increasingly recognized as a factor influencing renal outcomes in critical illness.
  • Further research should evaluate the impact and cost-effectiveness of balanced solutions in high-risk patient populations and specific resuscitation strategies.