Fluid management based on renal function considerations

Abstract

Intravenous fluid administration is one of the most commonly used interventions in acutely ill patients. Almost all hospitalized patients receive intravenous fluids for either volume resuscitation or as diluents for drug administration.  However, recent studies suggest that fluid overload is associated with acute kidney injury and that fluid administration beyond the volume needed to correct the fluid deficit is associated with increased morbidity, longer hospital stays, and mortality.  The exact cause and effect underlying this association remains uncertain.  Previous studies have reported a correlation between fluid overload and mortality in critically ill patients with acute respiratory distress syndrome, acute lung injury, sepsis, and acute kidney injury.  In patients with acute kidney injury, a higher percentage of fluid overload has been associated with higher mortality and shorter ventilator-free days starting during the initial management in the intensive care unit.  Similarly, in a large multicenter study, a positive fluid balance was an important factor associated with increased 60-day mortality in patients with acute kidney injury.  This review analyzes the use of intravenous fluids and renal function, including types of intravenous fluid, cumulative fluid targets, endpoint hemodynamic indicators, and renal replacement therapy for acute kidney injury.

Key words: volume status, intravenous fluids, fluid balance, acute kidney injury, volume excess