Document Detail


Fluid overload in AKI: epiphenomenon or putative effect on mortality?
MedLine Citation:
PMID:  23037878     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: The incidence of acute kidney injury (AKI) is increasing dramatically, and despite advances in dialytic therapy and critical care, there has been little improvement in associated morbidity and mortality. Recently, several articles have suggested that fluid overload in patients with AKI is associated with an increased risk of death.
RECENT FINDINGS: Observational studies have demonstrated an association between fluid overload and poor outcomes (including death) in patients with AKI; however, whether this association is causal or due to residual confounding is unknown. A recent study testing the impact of fluid overload and diuretics on outcomes in the context of a randomized controlled trial suggests that the beneficial impact of diuretics in those with AKI is mediated by reducing fluid overload. Finally, potential mechanisms by which fluid overload may contribute to death include failure to recognize AKI due to creatinine dilution, direct tissue edema leading to decreased renal perfusion, and an increased risk of other complications such as sepsis.
SUMMARY: On the basis of the current literature, the relative contributions of the direct effects of fluid overload versus the association of fluid overload with other patient characteristics associated with adverse outcome (e.g. sepsis) remain unknown. Additional human studies, including randomized controlled trials, are warranted to further clarify these issues.
Authors:
Brad W Butcher; Kathleen D Liu
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in critical care     Volume:  18     ISSN:  1531-7072     ISO Abbreviation:  Curr Opin Crit Care     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-16     Completed Date:  2013-05-10     Revised Date:  2014-04-24    
Medline Journal Info:
Nlm Unique ID:  9504454     Medline TA:  Curr Opin Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  593-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acute Kidney Injury / physiopathology,  therapy*
Diuretics / therapeutic use
Fluid Therapy / adverse effects,  mortality*
Hemodynamics / physiology
Humans
Intra-Abdominal Hypertension
Risk Assessment
Treatment Outcome
Grant Support
ID/Acronym/Agency:
N01 HR56166/HR/NHLBI NIH HHS; T32 DK007219/DK/NIDDK NIH HHS; T32 DK007219/DK/NIDDK NIH HHS; U01 DK082223/DK/NIDDK NIH HHS; U01 DK085649/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Diuretics
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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