Positive Fluid Balance and Association with Post-Traumatic Acute Kidney Injury.

Area of Science:

• Trauma critical care
• Nephrology
• Resuscitation medicine

Background:

• Acute kidney injury (AKI) is a frequent complication in severely injured trauma patients, correlating with adverse outcomes.
• Positive fluid balance is a known risk factor for AKI and long-term renal dysfunction in various critical care settings.
• The optimal resuscitation strategy for severe trauma remains undefined, potentially leading to excessive fluid administration.

Purpose of the Study:

• To investigate the hypothesis that positive fluid balance is prevalent after severe trauma.
• To determine the association between positive fluid balance and the development of AKI in trauma patients.

Main Methods:

• A cohort study included adult trauma patients admitted to the ICU between January and June 2017.
• Exclusion criteria included early death, rhabdomyolysis, or pre-existing end-stage renal disease/congestive heart failure.
• AKI diagnosis within 7 days was based on KDIGO creatinine criteria; statistical analyses included univariate and multivariable models.

Main Results:

• Of 364 patients, 49% had a positive fluid balance (>2 L).
• AKI developed in 105 patients (29%).
• A positive fluid balance >2 L was independently associated with increased AKI risk (RR 1.98). Each additional liter of positive balance increased AKI risk by 1.22.

Conclusions:

• Positive fluid balance exceeding 2 L is common (occurs in 50% of patients) within 48 hours post-severe trauma.
• Fluid positivity is independently and incrementally linked to AKI development.
• Investigating fluid responsiveness as a resuscitation endpoint may prevent excessive fluid administration and reduce AKI incidence.