Fluid management in acute kidney injury: from evaluating fluid responsiveness towards assessment of fluid tolerance

Author:

Argaiz Eduardo R1,Rola Philippe2,Haycock Korbin H3,Verbrugge Frederik H45ORCID

Affiliation:

1. Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubirán , Mexico City , Mexico

2. Intensive Care Unit, Santa Cabrini Hospital , Montréal, QC , Canada

3. Department of Emergency Medicine, Loma Linda University Health , Loma Linda, CA , USA

4. Centre for Cardiovascular Diseases, University Hospital Brussels , Laarbeeklaan 101, 1090 Jette , Belgium

5. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel , Brussels , Belgium

Abstract

Abstract Despite the widespread use of intravenous fluids in acute kidney injury (AKI), solid evidence is lacking. Intravenous fluids mainly improve AKI due to true hypovolaemia, which is difficult to discern at the bedside unless it is very pronounced. Empiric fluid resuscitation triggered only by elevated serum creatinine levels or oliguria is frequently misguided, especially in the presence of fluid intolerance syndromes such as increased extravascular lung water, capillary leak, intra-abdominal hypertension, and systemic venous congestion. While fluid responsiveness tests clearly identify patients who will not benefit from fluid administration (i.e. those without an increase in cardiac output), the presence of fluid responsiveness does not guarantee that fluid therapy is indicated or even safe. This review calls for more attention to the concept of fluid tolerance, incorporating it into a practical algorithm with systematic venous Doppler ultrasonography assessment to use at the bedside, thereby lowering the risk of detrimental kidney congestion in AKI.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

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