Fluid Balance in Continuous Renal Replacement Therapy: Prescribing, Delivering, and Review

Area of Science:

• Nephrology
• Critical Care Medicine
• Intensive Care Unit (ICU) Management

Background:

• Historically, fluid management in acute kidney injury (AKI) shifted from restriction to more liberal approaches with continuous renal replacement therapies (CRRTs).
• However, liberal fluid administration can lead to fluid accumulation if not carefully balanced with prescribed fluid volumes and net ultrafiltration (NUF) targets.

Purpose of the Study:

• To highlight the critical role of CRRT in achieving fluid balance in AKI patients.
• To emphasize the challenges and strategies for managing fluid balance in critically ill patients, particularly those with sepsis-associated AKI.

Main Methods:

• Focus on the importance of delivered CRRT hours for fluid balance achievement.
• Discusses the need for comprehensive assessment, including fluid load, daily fluid balance targets, and hourly NUF rates.
• Mentions potential future advancements in CRRT technology, such as machine learning and integrated monitoring systems.

Main Results:

• Delivered CRRT hours directly impact the ability to achieve daily fluid balance goals.
• Inexperienced clinicians require focused oversight and clear communication for effective AKI fluid management.
• Sepsis-associated AKI presents unique challenges due to initial resuscitation and subsequent fluid regulation needs.

Conclusions:

• Fluid balance in acutely ill patients necessitates accurate forecasting and prediction.
• Continuous tracking and adjustment of NUF rate and volume are essential for meeting daily fluid balance targets.
• Effective fluid management in AKI requires a synergistic approach involving both human clinical judgment and machine-assisted monitoring.