Clinical review: Volume of fluid resuscitation and the incidence of acute kidney injury - a systematic review
1 Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, UK
2 Division of Nephrology, University Medicine Cluster, National University Health System, 5 Lower Kentridge Road, Singapore 119074
3 Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C. Mackenzie Centre, 8440-122 Street, Edmonton, AB, T6G 2B7, Canada
4 Department of Intensive Care, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084, Australia
Critical Care 2012, 16:230 doi:10.1186/cc11345Published: 7 August 2012
Intravenous fluids are widely administered to maintain renal perfusion and prevent acute kidney injury (AKI). However, fluid overload is of concern during AKI. Using the Pubmed database (up to October 2011) we identified all randomised controlled studies of goal-directed therapy (GDT)-based fluid resuscitation (FR) reporting renal outcomes and documenting fluid given during perioperative care. In 24 perioperative studies, GDT was associated with decreased risk of postoperative AKI (odds ratio (OR) = 0.59, 95% confidence interval (CI) = 0.39 to 0.89) but additional fluid given was limited (median: 555 ml). Moreover, the decrease in AKI was greatest (OR = 0.47, 95% CI = 0.29 to 0.76) in the 10 studies where FR was the same between GDT and control groups. Inotropic drug use in GDT patients was associated with decreased AKI (OR = 0.52, 95% CI = 0.34 to 0.80, P = 0.003), whereas studies not involving inotropic drugs found no effect (OR = 0.75, 95% CI = 0.37 to 1.53, P = 0.43). The greatest protection from AKI occurred in patients with no difference in total fluid delivery and use of inotropes (OR = 0.46, 95% CI = 0.27 to 0.76, P = 0.0036). GDT-based FR may decrease AKI in surgical patients; however, this effect requires little overall FR and appears most effective when supported by inotropic drugs.