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01-06-2017 | Review

Fluid management in acute kidney injury

Authors: Anders Perner, John Prowle, Michael Joannidis, Paul Young, Peter B. Hjortrup, Ville Pettilä

Published in: Intensive Care Medicine | Issue 6/2017

Abstract

Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI.

Himmelfarb J, Joannidis M, Molitoris B et al (2008) Evaluation and initial management of acute kidney injury. Clin J Am Soc Nephrol 3:962–967. doi:10.2215/CJN.04971107 CrossRefPubMedPubMedCentral

Lehner GF, Forni LG, Joannidis M (2016) Oliguria and biomarkers of acute kidney injury: star struck lovers or strangers in the night? Nephron 134:183–190. doi:10.1159/000447979 CrossRefPubMed

Ostermann M, Joannidis M (2016) Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care 20:299. doi:10.1186/s13054-016-1478-z CrossRefPubMedPubMedCentral

Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf. Accessed 1 Jan 2017.

Cecconi M, Hofer C, Teboul J-L et al (2015) Fluid challenges in intensive care: the FENICE study: a global inception cohort study. Intensive Care Med 41:1529–1537. doi:10.1007/s00134-015-3850-x CrossRefPubMedPubMedCentral

Hoste EAJ, Bagshaw SM, Bellomo R et al (2015) Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med 41:1411–1423. doi:10.1007/s00134-015-3934-7 CrossRefPubMed

Ostermann M, Joannidis M, Pani A et al (2016) Patient selection and timing of continuous renal replacement therapy. Blood Purif 42:224–237. doi:10.1159/000448506 CrossRefPubMed

Raimundo M, Crichton S, Martin JR et al (2015) Increased fluid administration after early acute kidney injury is associated with less renal recovery. Shock Augusta Ga 44:431–437. doi:10.1097/SHK.0000000000000453 CrossRef

Prowle JR, Liu Y-L, Licari E et al (2011) Oliguria as predictive biomarker of acute kidney injury in critically ill patients. Crit Care 15:R172. doi:10.1186/cc10318 CrossRefPubMedPubMedCentral

10.

Vaara ST, Parviainen I, Pettilä V et al (2016) Association of oliguria with the development of acute kidney injury in the critically ill. Kidney Int 89:200–208. doi:10.1016/j.kint.2015.12.007 CrossRefPubMed

11.

Prowle JR, Ishikawa K, May CN, Bellomo R (2010) Renal plasma flow and glomerular filtration rate during acute kidney injury in man. Ren Fail 32:349–355. doi:10.3109/08860221003611695 CrossRefPubMed

12.

Calzavacca P, Evans RG, Bailey M et al (2015) Cortical and medullary tissue perfusion and oxygenation in experimental septic acute kidney injury. Crit Care Med 43:e431–e439. doi:10.1097/CCM.0000000000001198 CrossRefPubMed

13.

Prowle JR, Molan MP, Hornsey E, Bellomo R (2012) Measurement of renal blood flow by phase-contrast magnetic resonance imaging during septic acute kidney injury: a pilot investigation. Crit Care Med 40:1768–1776. doi:10.1097/CCM.0b013e318246bd85 CrossRefPubMed

14.

Parekh N, Veith U (1981) Renal hemodynamics and oxygen consumption during postischemic acute renal failure in the rat. Kidney Int 19:306–316CrossRefPubMed

15.

Redfors B, Bragadottir G, Sellgren J et al (2010) Acute renal failure is NOT an “acute renal success”—a clinical study on the renal oxygen supply/demand relationship in acute kidney injury. Crit Care Med 38:1695–1701. doi:10.1097/CCM.0b013e3181e61911 CrossRefPubMed

16.

Saotome T, Ishikawa K, May CN et al (2010) The impact of experimental hypoperfusion on subsequent kidney function. Intensive Care Med 36:533–540. doi:10.1007/s00134-009-1740-9 CrossRefPubMed

17.

De Backer D, Creteur J, Preiser J-C et al (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104CrossRefPubMed

18.

Lee WL, Slutsky AS (2010) Sepsis and endothelial permeability. N Engl J Med 363:689–691. doi:10.1056/NEJMcibr1007320 CrossRefPubMed

19.

Nijssen EC, Rennenberg RJ, Nelemans PJ et al (2017) Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Lancet. doi:10.1016/S0140-6736(17)30057-0 PubMed

20.

Legrand M, Le Cam B, Perbet S et al (2016) Urine sodium concentration to predict fluid responsiveness in oliguric ICU patients: a prospective multicenter observational study. Crit Care 20:165. doi:10.1186/s13054-016-1343-0 CrossRefPubMedPubMedCentral

21.

Zafrani L, Ergin B, Kapucu A, Ince C (2016) Blood transfusion improves renal oxygenation and renal function in sepsis-induced acute kidney injury in rats. Crit Care 20:406. doi:10.1186/s13054-016-1581-1 CrossRefPubMedPubMedCentral

22.

Hoste EA, Maitland K, Brudney CS et al (2014) Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth 113:740–747. doi:10.1093/bja/aeu300 CrossRefPubMed

23.

Hammond NE, Taylor C, Saxena M et al (2015) Resuscitation fluid use in Australian and New Zealand intensive care units between 2007 and 2013. Intensive Care Med 41:1611–1619. doi:10.1007/s00134-015-3878-y CrossRefPubMed

24.

Myburgh JA, Finfer S, Bellomo R et al (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 367:1901–1911. doi:10.1056/NEJMoa1209759 CrossRefPubMed

25.

Zarychanski R, Abou-Setta AM, Turgeon AF et al (2013) Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA 309:678–688. doi:10.1001/jama.2013.430 CrossRefPubMed

26.

Perner A, Haase N, Guttormsen AB et al (2012) Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med 367:124–134. doi:10.1056/NEJMoa1204242 CrossRefPubMed

27.

Haase N, Perner A, Hennings LI et al (2013) Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis. BMJ 346:f839CrossRefPubMedPubMedCentral

28.

Rochwerg B, Alhazzani W, Gibson A et al (2015) Fluid type and the use of renal replacement therapy in sepsis: a systematic review and network meta-analysis. Intensive Care Med 41:1561–1571. doi:10.1007/s00134-015-3794-1 CrossRefPubMed

29.

Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. doi:10.1007/s00134-017-4683-6

30.

FDA (2013) FDA Safety Communication: Boxed Warning on increased mortality and severe renal injury, and additional warning on risk of bleeding, for use of hydroxyethyl starch solutions in some settings. https://www.fda.gov/downloads/biologicsbloodvaccines/bloodbloodproducts/approvedproducts/newdrugapplicationsndas/ucm083138.pdf. Accessed 1 Jan 2017.

31.

EMA (2013) Hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Hydroxyethyl_starch-containing_solutions/human_referral_prac_000012.jsp&mid=WC0b01ac05805c516f. Accessed 1 Jan 2017.

32.

Moeller C, Fleischmann C, Thomas-Rueddel D et al (2016) How safe is gelatin? A systematic review and meta-analysis of gelatin-containing plasma expanders vs crystalloids and albumin. J Crit Care 35:75–83. doi:10.1016/j.jcrc.2016.04.011 CrossRefPubMed

33.

Bayer O, Reinhart K, Kohl M et al (2012) Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis. Crit Care Med 40:2543–2551. doi:10.1097/CCM.0b013e318258fee7 CrossRefPubMed

34.

Bayer O, Schwarzkopf D, Doenst T et al (2013) Perioperative fluid therapy with tetrastarch and gelatin in cardiac surgery—a prospective sequential analysis. Crit Care Med 41:2532–2542. doi:10.1097/CCM.0b013e3182978fb6 CrossRefPubMed

35.

Finfer S, Bellomo R, Boyce N et al (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256. doi:10.1056/NEJMoa040232 CrossRefPubMed

36.

Caironi P, Tognoni G, Masson S et al (2014) Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 370:1412–1421. doi:10.1056/NEJMoa1305727 CrossRefPubMed

37.

Perel P, Roberts I, Ker K (2013) Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. doi:10.1002/14651858.CD000567.pub6

38.

Wilcox CS (1983) Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726–735CrossRefPubMedPubMedCentral

39.

Chowdhury AH, Cox EF, Francis ST, Lobo DN (2012) A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and Plasma-Lyte^® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 256:18–24. doi:10.1097/SLA.0b013e318256be72 CrossRefPubMed

40.

Morsing P, Velazquez H, Ellison D, Wright FS (1993) Resetting of tubuloglomerular feedback by interrupting early distal flow. Acta Physiol Scand 148:63–68. doi:10.1111/j.1748-1716.1993.tb09532.x CrossRefPubMed

41.

Schnermann J, Ploth DW, Hermle M (1976) Activation of tubulo-glomerular feedback by chloride transport. Pflugers Arch 362:229–240CrossRefPubMed

42.

Handy JM, Soni N (2008) Physiological effects of hyperchloraemia and acidosis. Br J Anaesth 101:141–150. doi:10.1093/bja/aen148 CrossRefPubMed

43.

Morgan TJ, Venkatesh B, Hall J (2002) Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution. Crit Care Med 30:157–160CrossRefPubMed

44.

Krajewski ML, Raghunathan K, Paluszkiewicz SM et al (2015) Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg 102:24–36. doi:10.1002/bjs.9651 CrossRefPubMed

45.

Yunos NM, Bellomo R, Hegarty C et al (2012) Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 308:1566–1572. doi:10.1001/jama.2012.13356 CrossRefPubMed

46.

Bayer O, Reinhart K, Sakr Y et al (2011) Renal effects of synthetic colloids and crystalloids in patients with severe sepsis: a prospective sequential comparison. Crit Care Med 39:1335–1342. doi:10.1097/CCM.0b013e318212096a CrossRefPubMed

47.

Yunos NM, Bellomo R, Glassford N et al (2015) Chloride-liberal vs. chloride-restrictive intravenous fluid administration and acute kidney injury: an extended analysis. Intensive Care Med 41:257–264. doi:10.1007/s00134-014-3593-0 CrossRefPubMed

48.

Raghunathan K, Shaw A, Nathanson B et al (2014) Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med 42:1585–1591. doi:10.1097/CCM.0000000000000305 CrossRefPubMed

49.

Shaw AD, Schermer CR, Lobo DN et al (2015) Impact of intravenous fluid composition on outcomes in patients with systemic inflammatory response syndrome. Crit Care 19:334. doi:10.1186/s13054-015-1045-z CrossRefPubMedPubMedCentral

50.

Young P, Bailey M, Beasley R et al (2015) Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial. JAMA 314:1701–1710. doi:10.1001/jama.2015.12334 CrossRefPubMed

51.

Semler MW, Wanderer JP, Ehrenfeld JM et al (2016) Balanced crystalloids versus saline in the intensive care unit: the SALT randomized trial. Am J Respir Crit Care Med. doi:10.1164/rccm.201607-1345OC

52.

Sen A, Keener CM, Sileanu FE et al (2017) Chloride content of fluids used for large-volume resuscitation is associated with reduced survival. Crit Care Med 45:e146–e153. doi:10.1097/CCM.0000000000002063 CrossRefPubMed

53.

Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377. doi:10.1056/NEJMoa010307 CrossRefPubMed

54.

Pettilä V, Bellomo R (2014) Understanding acute kidney injury in sepsis. Intensive Care Med 40:1018–1020. doi:10.1007/s00134-014-3313-9 CrossRefPubMed

55.

Chen KP, Cavender S, Lee J et al (2016) Peripheral edema, central venous pressure, and risk of AKI in critical illness. Clin J Am Soc Nephrol CJASN 11:602–608. doi:10.2215/CJN.08080715 CrossRefPubMedPubMedCentral

56.

Bihari S, Baldwin CE, Bersten AD (2013) Fluid balance does not predict estimated sodium balance in critically ill mechanically ventilated patients. Crit Care Resusc 15:89–96PubMed

57.

Glassford NJ, Mårtensson J, Eastwood GM et al (2016) Defining the characteristics and expectations of fluid bolus therapy: a worldwide perspective. J Crit Care 35:126–132. doi:10.1016/j.jcrc.2016.05.017 CrossRefPubMed

58.

Hjortrup PB, Haase N, Bundgaard H et al (2016) Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med 42:1695–1705. doi:10.1007/s00134-016-4500-7 CrossRefPubMed

59.

Silversides JA, Major E, Ferguson AJ et al (2016) Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. doi:10.1007/s00134-016-4573-3 PubMed

60.

Investigators ProCESS, Yealy DM, Kellum JA et al (2014) A randomized trial of protocol-based care for early septic shock. N Engl J Med 370:1683–1693. doi:10.1056/NEJMoa1401602 CrossRef

61.

Teixeira C, Garzotto F, Piccinni P et al (2013) Fluid balance and urine volume are independent predictors of mortality in acute kidney injury. Crit Care 17:R14. doi:10.1186/cc12484 CrossRefPubMedPubMedCentral

62.

Vaara ST, Korhonen A-M, Kaukonen K-M et al (2012) Fluid overload is associated with an increased risk for 90-day mortality in critically ill patients with renal replacement therapy: data from the prospective FINNAKI study. Crit Care 16:R197. doi:10.1186/cc11682 CrossRefPubMedPubMedCentral

63.

Rosner MH, Ostermann M, Murugan R et al (2014) Indications and management of mechanical fluid removal in critical illness. Br J Anaesth 113:764–771. doi:10.1093/bja/aeu297 CrossRefPubMed

64.

Prowle JR, Kirwan CJ, Bellomo R (2014) Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol 10:37–47. doi:10.1038/nrneph.2013.232 CrossRefPubMed

65.

Ho KM, Sheridan DJ (2006) Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ 333:420. doi:10.1136/bmj.38902.605347.7C CrossRefPubMedPubMedCentral

66.

Mehta RL, Pascual MT, Soroko S et al (2002) Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 288:2547–2553CrossRefPubMed

67.

Uchino S, Doig GS, Bellomo R et al (2004) Diuretics and mortality in acute renal failure. Crit Care Med 32:1669–1677CrossRefPubMed

68.

Goldstein S, Bagshaw S, Cecconi M et al (2014) Pharmacological management of fluid overload. Br J Anaesth 113:756–763. doi:10.1093/bja/aeu299 CrossRefPubMed

69.

Schneider AG, Baldwin I, Freitag E et al (2012) Estimation of fluid status changes in critically ill patients: fluid balance chart or electronic bed weight? J Crit Care 27:745.e7–745.e12. doi:10.1016/j.jcrc.2011.12.017 CrossRef

70.

Uszko-Lencer NHMK, Bothmer F, van Pol PEJ, Schols AMWJ (2006) Measuring body composition in chronic heart failure: a comparison of methods. Eur J Heart Fail 8:208–214. doi:10.1016/j.ejheart.2005.07.007 CrossRefPubMed

71.

Chen H, Wu B, Gong D, Liu Z (2015) Fluid overload at start of continuous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combined use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement. Crit Care 19:135. doi:10.1186/s13054-015-0871-3 CrossRefPubMedPubMedCentral

72.

Jones SL, Tanaka A, Eastwood GM et al (2015) Bioelectrical impedance vector analysis in critically ill patients: a prospective, clinician-blinded investigation. Crit Care 19:290. doi:10.1186/s13054-015-1009-3 CrossRefPubMedPubMedCentral

73.

Mikkelsen ME, Christie JD, Lanken PN et al (2012) The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med 185:1307–1315. doi:10.1164/rccm.201111-2025OC CrossRefPubMedPubMedCentral

74.

Grissom CK, Hirshberg EL, Dickerson JB et al (2015) Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome. Crit Care Med 43:288–295. doi:10.1097/CCM.0000000000000715 CrossRefPubMedPubMedCentral

75.

Boulain T, Boisrame-Helms J, Ehrmann S et al (2015) Volume expansion in the first 4 days of shock: a prospective multicentre study in 19 French intensive care units. Intensive Care Med 41:248–256. doi:10.1007/s00134-014-3576-1 CrossRefPubMed

76.

Hjortrup PB, Haase N, Wetterslev J et al (2017) Effects of fluid restriction on measures of circulatory efficacy in adults with septic shock. Acta Anaesthesiol Scand. doi:10.1111/aas.12862

77.

Guidet B, Martinet O, Boulain T, Philippart F, Poussel J, Maizel J, Forceville X, Feissel M, Hasselmann M, Heininger A, Aken HV (2012) Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Critical Care 16(3):R94CrossRefPubMedPubMedCentral

Title: Fluid management in acute kidney injury
Authors: Anders Perner
John Prowle
Michael Joannidis
Paul Young
Peter B. Hjortrup
Ville Pettilä
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 6/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4817-x

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