Intravenous fluids: effects on renal outcomes

Abstract

Intravenous fluid therapy is the most commonly prescribed inpatient medication in hospitals around the world. Intravenous fluids are drugs and have an indication, a dose, and expected and unintended effects. The type and amount of fluid given to patients are both important, and can either hasten or slow recovery depending on how they are administered. This narrative review provides a brief summary of the effect of intravenous fluid administration on kidney function and on renal outcome measures of relevance to both patients and clinicians. Several large clinical trials of fluid therapy are currently underway, the results of which are likely to change clinical practice.

Выбор Инфузионных Сред При Периоперационной Волемической Поддержке

“…Использование ГЭК 130/0,4 изучалось в нескольких небольших РКИ, включающих абдоминальные, ортопедические или сосудистые операции [4]. Во всех исследованиях ГЭК 130/0,4 не увеличивал риск развития ОПП по сравнению с кристаллоидами или желатином.…”

Management of Common Postoperative Complications

“…Balanced crystalloid solutions (electrolyte composition resembling plasma) may be preferred over normal saline to avoid hyperchloremic acidosis, which can cause renal vasoconstriction and reduced glomerular filtration rate. 13,17,[23][24][25] Debate remains regarding the use of colloid solutions, although the use of synthetic colloids, such as hydroxyethyl starches, is not recommended due to the association with renal injury. 13,23,26 The use of albumin remains controversial, although there may be a role in certain patient populations (such as patients who are hypoalbuminemic).…”

“…13,17,[23][24][25] Debate remains regarding the use of colloid solutions, although the use of synthetic colloids, such as hydroxyethyl starches, is not recommended due to the association with renal injury. 13,23,26 The use of albumin remains controversial, although there may be a role in certain patient populations (such as patients who are hypoalbuminemic). 13,23 The presence of anemia, whether pre-or postoperatively, reduces the blood's oxygen carrying capacity and increases the risk for AKI.…”

“…13,23,26 The use of albumin remains controversial, although there may be a role in certain patient populations (such as patients who are hypoalbuminemic). 13,23 The presence of anemia, whether pre-or postoperatively, reduces the blood's oxygen carrying capacity and increases the risk for AKI. 13,27 Preoperative hemoglobin should be optimized ideally to normal range for age and sex, or reasonable goal of greater than 12.0 g/dL 28 before elective surgery to mitigate the effect of surgical blood loss and prevent the need for transfusions.…”

Another nail in the saline coffin

“…8,10,11 The overall evidence clearly provides a harm signal associated with hyperchloraemic crystalloid solutions without a comparable benefit signal, and supports the use of balanced instead of hyperchloraemic crystalloid solutions in most acute care patients. 12 The low chloride load associated with the administration of small volumes of normal saline may be well handled by patients at low risk for AKI. 13 However, this can clearly not be expected in patients with pre-existing renal dysfunction or metabolic acidosis, and in those receiving large volumes of hyperchloraemic solutions even in the absence of renal or metabolic abnormalities.…”