Intravenous fluids are widely administered to patients who have, or are at risk of, acute kidney injury (AKI). However, deleterious consequences of overzealous fluid therapy are increasingly being recognized. Salt and water overload can predispose to organ dysfunction, impaired wound healing and nosocomial infection, particularly in patients with AKI, in whom fluid challenges are frequent and excretion is impaired. In this Review article, we discuss how interstitial edema can further delay renal recovery and why conservative fluid strategies are now being advocated. Applying these strategies in critical illness is challenging. Although volume resuscitation is needed to restore cardiac output, it often leads to tissue edema, thereby contributing to ongoing organ dysfunction. Conservative strategies of fluid management mandate a switch towards neutral balance and then negative balance once hemodynamic stabilization is achieved. In patients with AKI, this strategy might require renal replacement therapy to be given earlier than when more-liberal fluid management is used. However, hypovolemia and renal hypoperfusion can occur in patients with AKI if excessive fluid removal is pursued with diuretics or extracorporeal therapy. Thus, accurate assessment of fluid status and careful definition of targets are needed at all stages to improve clinical outcomes. A conservative strategy of fluid management was recently tested and found to be effective in a large, randomized, controlled trial in patients with acute lung injury. Similar randomized, controlled studies in patients with AKI now seem justified.
Fluid therapy is common in patients at risk of acute kidney injury (AKI)
Prolonged fluid resuscitation leads to edema in the kidneys and other organs
Fluid overload is associated with increased morbidity
An early transition to a fluid-restrictive strategy might be beneficial in patients with AKI
Fluid removal in patients with or at risk of AKI should be implemented with appropriate monitoring
Biomarkers and/or novel fluid assessment methods might contribute to safer fluid management
Subscribe to Journal
Get full journal access for 1 year
only $17.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Brady, H. R., Clarkson, M. R. & Lieberthal, W. in Brenner and Rector's The Kidney (ed. Brenner, B. M.) 1260 (W. B. Saunders, Philadelphia, 2004).
Jindal, K. K. Management of idiopathic crescentic and diffuse proliferative glomerulonephritis: evidence-based recommendations. Kidney Int. Suppl. 70, S33–S40 (1999).
Kellum, J. A., Cerda, J., Kaplan, L. J., Nadim, M. K. & Palevsky, P. M. Fluids for prevention and management of acute kidney injury. Int. J. Artif. Organs 31, 96–110 (2008).
Leblanc, M. et al. Risk factors for acute renal failure: inherent and modifiable risks. Curr. Opin. Crit. Care 11, 533–536 (2005).
Brandstrup, B. et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann. Surg. 238, 641–648 (2003).
Payen, D. et al. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit. Care 12, R74 (2008).
Stewart, R. M. et al. Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. J. Am. Coll. Surg. 208, 725–735 (2009).
Brady, H. R. & Singer, G. G. Acute renal failure. Lancet 346, 1533–1540 (1995).
Brady, H. R., Clarkson, M. R. & Lieberthal, W. in Brenner and Rector's The Kidney (ed. Brenner, B. M.) 1215 (W. B. Saunders, Philadelphia, 2004).
Badr, K. F. & Ichikawa, I. Prerenal failure: a deleterious shift from renal compensation to decompensation. N. Engl. J. Med. 319, 623–629 (1988).
Blantz, R. C. Pathophysiology of pre-renal azotemia. Kidney Int. 53, 512–523 (1998).
Lieberthal, W. Biology of ischemic and toxic renal tubular cell injury: role of nitric oxide and the inflammatory response. Curr. Opin. Nephrol. Hypertens. 7, 289–295 (1998).
Sheridan, A. M. & Bonventre, J. V. Cell biology and molecular mechanisms of injury in ischemic acute renal failure. Curr. Opin. Nephrol. Hypertens. 9, 427–434 (2000).
Sutton, T. A., Fisher, C. J. & Molitoris, B. A. Microvascular endothelial injury and dysfunction during ischemic acute renal failure. Kidney Int. 62, 1539–1549 (2002).
Bull, G. M., Joekes, A. M. & Lowe, K. G. Renal function studies in acute tubular necrosis. Clin. Sci. 9, 379–404 (1950).
Bagshaw, S. M., Langenberg, C. & Bellomo, R. Urinary biochemistry and microscopy in septic acute renal failure: a systematic review. Am. J. Kidney Dis. 48, 695–705 (2006).
Eckardt, K. U. Acute renal failure—more than kidney ischemia? Wien. Klin. Wochenschr. 112, 145–148 (2000).
Brezis, M., Rosen, S., Silva, P. & Epstein, F. H. Selective vulnerability of the medullary thick ascending limb to anoxia in the isolated perfused rat kidney. J. Clin. Invest. 73, 182–190 (1984).
Brezis, M., Heyman, S. N. & Epstein, F. H. Determinants of intrarenal oxygenation. II. Hemodynamic effects. Am. J. Physiol. 267, F1063–F1068 (1994).
Whitehouse, T., Stotz, M., Taylor, V., Stidwill, R. & Singer, M. Tissue oxygen and hemodynamics in renal medulla, cortex, and corticomedullary junction during hemorrhage-reperfusion. Am. J. Physiol. Renal Physiol. 291, F647–F653 (2006).
Langenberg, C., Bagshaw, S. M., May, C. N. & Bellomo, R. The histopathology of septic acute kidney injury: a systematic review. Crit. Care 12, R38 (2008).
Racusen, L. C. Pathology of acute renal failure: structure/function correlations. Adv. Ren. Replace. Ther. 4, 3–16 (1997).
Solez, K. & Racusen, L. C. Role of the renal biopsy in acute renal failure. Contrib. Nephrol. 68–75 (2001).
Sladen, R. N. Oliguria in the ICU. Systematic approach to diagnosis and treatment. Anesthesiol. Clin. North America 18, 739–752, viii (2000).
Bouchard, J. et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 76, 422–427 (2009).
Rahbari, N. N. et al. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. Br. J. Surg. 96, 331–341 (2009).
Chong, P. C. et al. Substantial variation of both opinions and practice regarding perioperative fluid resuscitation. Can. J. Surg. 52, 207–214 (2009).
Lobo, D. N., Dube, M. G., Neal, K. R., Allison, S. P. & Rowlands, B. J. Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK. Ann. R. Coll. Surg. Engl. 84, 156–160 (2002).
Walsh, S. R. et al. Perioperative fluid management: prospective audit. Int. J. Clin. Pract. 62, 492–497 (2008).
Maddox, D. A. & Brenner, B. M. in Brenner and Rector's The Kidney (ed. Brenner, B. M.) 353–362 (W. B. Saunders, Philadelphia, 2004).
Liu, Y. L., Prowle, J., Licari, E., Uchino, S. & Bellomo, R. Changes in blood pressure before the development of nosocomial acute kidney injury. Nephrol. Dial. Transplant. 24, 504–511 (2009).
Schrier, R. W. Body fluid volume regulation in health and disease: a unifying hypothesis. Ann. Intern. Med. 113, 155–159 (1990).
Opie, L. H. in Braunwald's Heart Disease, 8th edn (eds Libby, P., Bonow, R. O., Mann, D. L. & Zipes, D. P.) 526–534 (Saunders Elsevier, Philadelphia, 2007).
Weil, M. H. Shock and fluid resuscitation. The Merck Manuals Online Medical Library [online], (2007).
LeDoux, D., Astiz, M. E., Carpati, C. M. & Rackow, E. C. Effects of perfusion pressure on tissue perfusion in septic shock. Crit. Care Med. 28, 2729–2732 (2000).
Marik, P. E., Baram, M. & Vahid, B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest 134, 172–178 (2008).
Michard, F. & Teboul, J. L. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121, 2000–2008 (2002).
Bouhemad, B. et al. Isolated and reversible impairment of ventricular relaxation in patients with septic shock. Crit. Care Med. 36, 766–774 (2008).
Bouhemad, B. et al. Acute left ventricular dilatation and shock-induced myocardial dysfunction. Crit. Care Med. 37, 441–447 (2009).
Rudiger, A. & Singer, M. Mechanisms of sepsis-induced cardiac dysfunction. Crit. Care Med. 35, 1599–1608 (2007).
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 20, 864–874 (1992).
Di Giantomasso, D., May, C. N. & Bellomo, R. Vital organ blood flow during hyperdynamic sepsis. Chest 124, 1053–1059 (2003).
Ruokonen, E. et al. Regional blood flow and oxygen transport in septic shock. Crit. Care Med. 21, 1296–1303 (1993).
Fleck, A. et al. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet 325, 781–784 (1985).
Murphy, C. V. et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest 136, 102–109 (2009).
Heyland, D. K., Cook, D. J., King, D., Kernerman, P. & Brun-Buisson, C. Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Crit. Care Med. 24, 517–524 (1996).
Wan, L., Bellomo, R. & May, C. N. The effect of normal saline resuscitation on vital organ blood flow in septic sheep. Intensive Care Med. 32, 1238–1242 (2006).
Wan, L., Bellomo, R. & May, C. N. A comparison of 4% succinylated gelatin solution versus normal saline in stable normovolaemic sheep: global haemodynamic, regional blood flow and oxygen delivery effects. Anaesth. Intensive Care 35, 924–931 (2007).
Perel, P. & Roberts, I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews. Issue 4. Art. No.: CD000567. doi:10.1002/14651858.CD000567.pub3 (2007).
Jungheinrich, C., Scharpf, R., Wargenau, M., Bepperling, F. & Baron, J. F. The pharmacokinetics and tolerability of an intravenous infusion of the new hydroxyethyl starch 130/0.4 (6%, 500 ml) in mild-to-severe renal impairment. Anesth. Analg. 95, 544–551 (2002).
Berson, S. A., Yalow, R. S., Schrieber, S. S. & Post, J. Tracer experiments with I131 labelled human serum albumin: distribution and degradation studies. J. Clin. Invest. 32, 746–768 (1953).
Finfer, S. et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N. Engl. J. Med. 350, 2247–2256 (2004).
Brunkhorst, F. M. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N. Engl. J. Med. 358, 125–139 (2008).
Schortgen, F. et al. Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 357, 911–916 (2001).
Schortgen, F., Girou, E., Deye, N., Brochard, L. & CRYCO Study Group. The risk associated with hyperoncotic colloids in patients with shock. Intensive Care Med. 34, 2157–2168 (2008).
Molitoris, B. A. & Bacallao, R. Pathophysiology of ischemic acute renal failure: cytoskeletal aspects. Atlas of Diseases of the Kidney: Online Edition [online], (1998).
McCullough, P. A. Acute kidney injury with iodinated contrast. Crit. Care Med. 36, S204–S211 (2008).
Sever, M. S., Vanholder, R. & Lameire, N. Management of crush-related injuries after disasters. N. Engl. J. Med. 354, 1052–1063 (2006).
Frassetto, L., Morris, R. C., Sellmeyer, D. E., Todd, K. & Sebastian, A. Diet, evolution and aging—the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet. Eur. J. Nutr. 40, 200–213 (2001).
Langenberg, C. et al. Urinary biochemistry in experimental septic acute renal failure. Nephrol. Dial. Transplant. 21, 3389–3397 (2006).
Powell-Tuck, J. et al. British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP) [online], (2008).
Pinsky, M. R., Brophy, P., Padilla, J., Paganini, E. & Pannu, N. Fluid and volume monitoring. Int. J. Artif. Organs 31, 111–126 (2008).
Reid, F., Lobo, D. N., Williams, R. N., Rowlands, B. J. & Allison, S. P. (Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study. Clin. Sci. (Lond.) 104, 17–24 (2003).
Scheingraber, S., Rehm, M., Sehmisch, C. & Finsterer, U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 90, 1265–1270 (1999).
Wilcox, C. S. Regulation of renal blood flow by plasma chloride. J. Clin. Invest. 71, 726–735 (1983).
Williams, E. L., Hildebrand, K. L., McCormick, S. A. & Bedel, M. J. The effect of intravenous lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth. Analg. 88, 999–1003 (1999).
Malbrain, M. L. et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med. 32, 1722–1732 (2006).
Doty, J. M. et al. Effects of increased renal parenchymal pressure on renal function. J. Trauma 48, 874–877 (2000).
Wauters, J. et al. Pathophysiology of renal hemodynamics and renal cortical microcirculation in a porcine model of elevated intra-abdominal pressure. J. Trauma 66, 713–719 (2009).
Malbrain, M. L. et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit. Care Med. 33, 315–322 (2005).
Dalfino, L., Tullo, L., Donadio, I., Malcangi, V. & Brienza, N. Intra-abdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med. 34, 707–713 (2008).
Vidal, M. G. et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit. Care Med. 36, 1823–1831 (2008).
Firth, J. D., Raine, A. E. & Ledingham, J. G. Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet 331, 1033–1035 (1988).
Mullens, W. et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J. Am. Coll. Cardiol. 53, 589–596 (2009).
Stone, H. H. & Fulenwider, J. T. Renal decapsulation in the prevention of post-ischemic oliguria. Ann. Surg. 186, 343–355 (1977).
Ramaswamy, D. et al. Maintenance and recovery stages of postischemic acute renal failure in humans. Am. J. Physiol. Renal Physiol. 282, F271–F280 (2002).
Desai, K. V. et al. Mechanics of the left ventricular myocardial interstitium: effects of acute and chronic myocardial edema. Am. J. Physiol. Heart Circ. Physiol. 294, H2428–H2434 (2008).
Madias, J. E. Apparent amelioration of bundle branch blocks and intraventricular conduction delays mediated by anasarca. J. Electrocardiol. 38, 160–165 (2005).
Boyle, A., Maurer, M. S. & Sobotka, P. A. Myocellular and interstitial edema and circulating volume expansion as a cause of morbidity and mortality in heart failure. J. Card. Fail. 13, 133–136 (2007).
Humphrey, H., Hall, J., Sznajder, I., Silverstein, M. & Wood, L. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest 97, 1176–1180 (1990).
Nisanevich, V. et al. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103, 25–32 (2005).
Schrier, R. W. & Wang, W. Acute renal failure and sepsis. N. Engl. J. Med. 351, 159–169 (2004).
Rosenberg, A. L. et al. Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort. J. Intensive Care Med. 24, 35–46 (2009).
Sakr, Y. et al. High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest 128, 3098–3108 (2005).
Martin, G. S. et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit. Care Med. 30, 2175–2182 (2002).
Martin, G. S. et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit. Care Med. 33, 1681–1687 (2005).
McArdle, G. T. et al. Preliminary results of a prospective randomized trial of restrictive versus standard fluid regime in elective open abdominal aortic aneurysm repair. Ann. Surg. 250, 28–34 (2009).
The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N. Engl. J. Med. 354, 2564–2575 (2006).
Rivers, E. et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N. Engl. J. Med. 345, 1368–1377 (2001).
Monnet, X. & Teboul, J. L. Volume responsiveness. Curr. Opin. Crit. Care 13, 549–553 (2007).
Gombos, E. A. et al. Reactivity of renal and systemic circulations to vasoconstrictor agents in normotensive and hypertensive subjects. J. Clin. Invest. 41, 203–217 (1962).
Richer, M., Robert, S. & Lebel, M. Renal hemodynamics during norepinephrine and low-dose dopamine infusions in man. Crit. Care Med. 24, 1150–1156 (1996).
Albanèse, J. et al. Renal effects of norepinephrine in septic and nonseptic patients. Chest 126, 534–539 (2004).
Bellomo, R. & Giantomasso, D. D. Noradrenaline and the kidney: friends or foes? Crit. Care 5, 294–298 (2001).
Bellomo, R., Wan, L. & May, C. Vasoactive drugs and acute kidney injury. Crit. Care Med. 36, S179–S186 (2008).
Bourgoin, A. et al. Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function. Crit. Care Med. 33, 780–786 (2005).
Di Giantomasso, D., Morimatsu, H., May, C. N. & Bellomo, R. Intrarenal blood flow distribution in hyperdynamic septic shock: effect of norepinephrine. Crit. Care Med. 31, 2509–2513 (2003).
Di Giantomasso, D., Morimatsu, H., May, C. N. & Bellomo, R. Increasing renal blood flow: low-dose dopamine or medium-dose norepinephrine. Chest 125, 2260–2267 (2004).
Arlati, S. et al. Decreased fluid volume to reduce organ damage: a new approach to burn shock resuscitation? A preliminary study. Resuscitation 72, 371–378 (2007).
Uchino, S. et al. Diuretics and mortality in acute renal failure. Crit. Care Med. 32, 1669–1677 (2004).
Mehta, R. L. et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 288, 2547–2553 (2002).
Asare, K. Management of loop diuretic resistance in the intensive care unit. Am. J. Health Syst. Pharm. 66, 1635–1640 (2009).
Martin, G. S. Fluid balance and colloid osmotic pressure in acute respiratory failure: emerging clinical evidence. Crit. Care 4 (Suppl. 2), S21–S25 (2000).
Karajala, V., Mansour, W. & Kellum, J. A. Diuretics in acute kidney injury. Minerva Anestesiol. 75, 251–257 (2009).
van der Voort, P. H. et al. Furosemide does not improve renal recovery after hemofiltration for acute renal failure in critically ill patients: a double blind randomized controlled trial. Crit. Care Med. 37, 533–538 (2009).
Zucchelli, P. & Santoro, A. Dialysis-induced hypotension: a fresh look at pathophysiology. Blood Purif. 11, 85–98 (1993).
Conger, J. D. Does hemodialysis delay recovery from acute renal failure? Semin. Dial. 3, 146–148 (1990).
Manns, M., Sigler, M. H. & Teehan, B. P. Intradialytic renal haemodynamics—potential consequences for the management of the patient with acute renal failure. Nephrol. Dial. Transplant. 12, 870–872 (1997).
Bouchard, J. & Mehta, R. L. Volume management in continuous renal replacement therapy. Semin. Dial. 22, 146–150 (2009).
Lin, Y. F. et al. The 90-day mortality and the subsequent renal recovery in critically ill surgical patients requiring acute renal replacement therapy. Am. J. Surg. 198, 325–332 (2009).
Bell, M. et al. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure. Intensive Care Med. 33, 773–780 (2007).
Bagshaw, S. M. et al. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit. Care 9, R700–R709 (2005).
Jacka, M. J., Ivancinova, X. & Gibney, R. T. Continuous renal replacement therapy improves renal recovery from acute renal failure. Can. J. Anaesth. 52, 327–332 (2005).
The RENAL Replacement Therapy Study Investigators. Intensity of continuous renal-replacement therapy in critically ill patients. N. Engl. J. Med. 361, 1627–1638 (2009).
Bagshaw, S. M. et al. Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J. Crit. Care 24, 129–140 (2009).
Doi, K. et al. Reduced production of creatinine limits its use as marker of kidney injury in sepsis. J. Am. Soc. Nephrol. 20, 1217–1221 (2009).
Haase-Fielitz, A. et al. Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery—a prospective cohort study. Crit. Care Med. 37, 553–560 (2009).
Wabel, P., Chamney, P., Moissl, U. & Jirka, T. Importance of whole-body bioimpedance spectroscopy for the management of fluid balance. Blood Purif. 27, 75–80 (2009).
Wynne, J. L. et al. Impedance cardiography: a potential monitor for hemodialysis. J. Surg. Res. 133, 55–60 (2006).
Zaluska, W. T. et al. Relative underestimation of fluid removal during hemodialysis hypotension measured by whole body bioimpedance. ASAIO J. 44, 823–827 (1998).
Ronco, C., Bellomo, R. & Ricci, Z. Hemodynamic response to fluid withdrawal in overhydrated patients treated with intermittent ultrafiltration and slow continuous ultrafiltration: role of blood volume monitoring. Cardiology 96, 196–201 (2001).
Steuer, R. R. et al. Enhanced fluid removal guided by blood volume monitoring during chronic hemodialysis. Artif. Organs 22, 627–632 (1998).
Davenport, A. Can advances in hemodialysis machine technology prevent intradialytic hypotension? Semin. Dial. 22, 231–236 (2009).
Jacobs, L. H. et al. Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study. Nephrol. Dial. Transplant. doi:10.1093/ndt/gfp417
Tripepi, G. et al. Biomarkers of left atrial volume: a longitudinal study in patients with end stage renal disease. Hypertension 54, 818–824 (2009).
Australian and New Zealand Intensive Care Society Clinical Trials Group, The George Institute & Fresenius Kabi. Crystalloid versus hydroxyethyl starch trials (CHEST): a multi-centre randomized controlled trial of fluid resuscitation with starch (6% hydroxyethyl starch 130/0.4) compared to saline (0.9% sodium chloride) in intensive care patients on mortality. ClinicalTrials.gov: NCT00935168 [online] (2009).
Mitchell, J. P., Schuller, D., Calandrino, F. S. & Schuster, D. P. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am. Rev. Respir. Dis. 145, 990–998 (1992).
Adesanya, A., Rosero, E., Timaran, C., Clagett, P. & Johnston, W. E. Intraoperative fluid restriction predicts improved outcomes in major vascular surgery. Vasc. Endovascular Surg. 42, 531–536 (2008).
Désirée Lie, University of California, Orange, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
The authors declare no competing financial interests.
About this article
Cite this article
Prowle, J., Echeverri, J., Ligabo, E. et al. Fluid balance and acute kidney injury. Nat Rev Nephrol 6, 107–115 (2010). https://doi.org/10.1038/nrneph.2009.213
Journal of the American College of Surgeons (2020)
Mediators of the Impact of Hourly Net Ultrafiltration Rate on Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy
Critical Care Medicine (2020)
Impact of acute kidney injury on prognosis and the effect of tolvaptan in patients with hepatic ascites
Journal of Gastroenterology (2020)
Protocol and statistical analysis plan for the REstricted fluid therapy VERsus Standard trEatment in Acute Kidney Injury—REVERSE‐AKI randomized controlled pilot trial
Acta Anaesthesiologica Scandinavica (2020)