Fluid management in acute kidney injury

Perner, Anders; Prowle, John R.; Joannidis, Michael; Young, Paul; Hjortrup, Peter Buhl; Pettilä, Ville

doi:10.1007/s00134-017-4817-x

Cited by 91 publications

(60 citation statements)

References 78 publications

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“…Separately, edema driven rises in intra-abdominal pressure may inhibit renal venous drainage, further exacerbating the elevation of renal vascular pressure 43111112. High quality resuscitation care of the patient with sepsis includes an initial modest bolus of resuscitation fluid (30 mL/kg within the first three hours) followed by a frequent assessment with dynamic measures of fluid responsiveness to determine whether additional fluids or vasoactive drugs are indicated 113.…”

Section: Prevention and Medical Treatmentmentioning

confidence: 99%

Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

443

381

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Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.

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Section: Prevention and Medical Treatmentmentioning

confidence: 99%

Sepsis associated acute kidney injury

Poston

Koyner

2019

BMJ

443

381

View full text Add to dashboard Cite

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“…19 Although there were no differences in the overall mortality or occurrence of AKI, there was a nonsignificant trend towards a decreased need for RRT in the conservative management group compared with the control. 21 Similarly, sepsis studies suggest that fluid resuscitation for the prevention of AKI is most effective if given early and in a targeted manner to prevent excessive fluid administration but to maximize haemodynamic parameters. 20 Moreover, a higher diuretic dose after AKI had a protective effect on patient survival, suggesting that survival may be linked to improved fluid balance in patients with AKI.…”

Section: Husain-syed Et Almentioning

confidence: 99%

“…20 However, there is a paucity of data informing clinicians on fluid management strategies in patients with AKI, especially when ARDS is also present. 21 Similarly, sepsis studies suggest that fluid resuscitation for the prevention of AKI is most effective if given early and in a targeted manner to prevent excessive fluid administration but to maximize haemodynamic parameters. Data also support that after the initial 24 hours of critical illness, the maintenance of a net even fluid balance is important.…”

Section: Husain-syed Et Almentioning

confidence: 99%

Distant organ dysfunction in acute kidney injury

2019

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Acute kidney injury (AKI) is a common complication in critically ill patients and it is associated with increased morbidity and mortality. Epidemiological and clinical data show that AKI is linked to a wide range of distant organ injuries, with the lungs, heart, liver, and intestines representing the most clinically relevant affected organs. This distant organ injury during AKI predisposes patients to progression to multiple organ dysfunction syndrome and ultimately, death. The strongest direct evidence of distant organ injury occurring in AKI has been obtained from animal models. The identified mechanisms include systemic inflammatory changes, oxidative stress, increases in leucocyte trafficking and the activation of proapoptotic pathways.Understanding the pathways driving AKI-induced distal organ injury are critical for the development and refinement of therapies for the prevention and attenuation of AKI-related morbidity and mortality. The purpose of this review is to summarize both clinical and preclinical studies of AKI and its role in distant organ injury.

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“…Importantly, RVF can critically diminish renal function by increasing renal venous pressure, causing congestive AKI [9, 10]. Consequently, the right heart hemodynamic (RHH) parameters have been routinely assessed in all HTx candidates [11].…”

Section: Introductionmentioning

confidence: 99%

Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation

et al. 2018

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PurposeAcute kidney injury (AKI) frequently occurs after heart transplantation (HTx), but its relation to preoperative right heart hemodynamic (RHH) parameters remains unknown. Therefore, we aimed to determine their predictive properties for postoperative AKI severity within 30 days after HTx.MethodsFrom 1984 to 2016, all consecutive HTx recipients (n = 595) in our tertiary referral center were included and analyzed for the occurrence of postoperative AKI staged by the kidney disease improving global outcome criteria. The effects of preoperative RHH parameters on postoperative AKI were calculated using logistic regression, and predictive accuracy was assessed using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and area under the receiver operating characteristic curves (AUC).ResultsPostoperative AKI occurred in 430 (72%) patients including 278 (47%) stage 1, 66 (11%) stage 2, and 86 (14%) stage 3 cases. Renal replacement therapy (RRT) was administered in 41 (7%) patients. Patients with higher AKI stages had also higher baseline right atrial pressure (RAP; median 7, 7, 8, and in RRT 11 mmHg, p trend = 0.021), RAP-to-pulmonary capillary wedge pressure ratio (median 0.37, 0.36, 0.40, 0.47, p trend = 0.009), and lower pulmonary artery pulsatility index (PAPi) values (median 2.83, 3.17, 2.54, 2.31, p trend = 0.012). Higher RAP and lower PAPi values independently predicted AKI severity [adjusted odds ratio (OR) per doubling of RAP 1.16 (1.02–1.32), p = 0.029; of PAPi 0.85 (0.75–0.96), p = 0.008]. Based on IDI, NRI, and delta AUC, inclusion of these parameters improved the models’ predictive accuracy.ConclusionsPreoperative PAPi and RAP strongly predict the development of AKI early after HTx and can be used as early AKI predictors.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5159-z) contains supplementary material, which is available to authorized users.

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Fluid management in acute kidney injury

Cited by 91 publications

References 78 publications

Sepsis associated acute kidney injury

Sepsis associated acute kidney injury

Distant organ dysfunction in acute kidney injury

Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation

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