Fluids for Prevention and Management of Acute Kidney Injury

2008 ◽  
Vol 31 (2) ◽  
pp. 96-110 ◽  
Author(s):  
J. A. Kellum ◽  
J. Cerda ◽  
L. J. Kaplan ◽  
M. K. Nadim ◽  
P. M. Palevsky
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Volume Expansion ◽  
Kidney Injury ◽  
Residual Renal Function ◽  
Acid Base Balance ◽  
Acid Base ◽  
Future Studies ◽  
Base Balance

Fluids are the only known method of attenuating renal injury. Furthermore, whether for hydration, resuscitation or renal replacement therapy, fluid prescriptions must be tailored to the fluid and electrolyte, cardiovascular status and residual renal function of the patient. Different fluids have significantly different effects both on volume expansion as well as on the electrolyte and acid-base balance; while controversial, different fluids may even influence renal function differently. This systematic review focuses on fluids for prevention and management of acute kidney injury. We have reviewed the available evidence and have made recommendations for clinical practice and future studies.

scholarly journals P0601SAFETY AND EFFICACY OF INTRAVENOUS ADMINISTRATION OF RINGER'S LACTATE VERSUS NORMAL SALINE 0.9% SOLUTION IN PATIENTS WITH ACUTE KIDNEY INJURY AND ESTABLISHED CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marios Papasotiriou ◽  
Adamantia Mpratsiakou ◽  
Georgia Georgopoulou ◽  
Lamprini Balta ◽  
Paraskevi Pavlakou ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Acid Base Balance ◽  
Acid Base ◽  
Safety And Efficacy ◽  
Ringer’S Lactate ◽  
Base Balance ◽  
The Mean

Abstract Background and Aims Crystalline solutions, such as normal saline 0.9% (N/S 0.9%) and Ringer's Lactate (L/R), are readily administered for increasing plasma volume. Despite the utility of administering N/S 0.9% to hypovolemic patients, the dose of 154 mmol of sodium (Na) contained in 1 L exceeds the recommended daily dose increasing the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R solution has the advantage of lower Na content, significantly less chlorine and contains lactates which may be advantageous in patients with significant acidemia such as patients with acute kidney injury (AKI) and chronic kidney disease (CKD). The aim of the present study is to investigate the safety and efficacy of administration of L/R versus N/S 0.9% in patients with prerenal AKI and established CKD. Method The study included adult patients with known CKD stage II to V without need for dialysis, with prerenal AKI (AKIN Stage I to III Criteria). Patients with other forms of AKI as well as hypervolemia, heart congestion or hyperkalemia (serum K>5.5 meq/l) were excluded from the study. Patients were randomized in 1:1 ratio to receive intravenously either N/S 0.9% or L/R solution at a dose of 20 ml/kg body weight/day. We studied kidney function (eGFR: CKD-EPI) and response to treatment at discharge and at 30 days after discharge, duration of hospitalization, improvement in serum bicarbonate levels (HCO3), acid-base balance, serum potassium levels and the need for dialysis. Results The study included 26 patients (17 males) with a mean age of 59.1 ± 16.1 years. Thirteen patients received treatment with N/S 0.9% and the rest with L/R solution. Baseline demographic and clinical characteristics at hospital admission and historical data did not show any significant differences in both groups of patients. Renal function at the onset of AKI did not show significant differences between the two groups (16.4 ± 5.8 vs 16.9 ± 5.7 ml/min/1.73 m2, p=ns, treatment with N/S and L/R respectively). The mean volume of solutions received by the two groups (N/S 0.9% 1119 ± 374 vs L/R 1338 ± 364 ml/day, p=ns) as well as the mean total volume of liquids received per day, did not differ significantly (2888 ± 821 vs 3069 ± 728 ml/d, p=ns). Patients treated with L/R were discharged 1 day earlier than patients treated with N/S (5.2 ± 3.2 vs 6.2 ± 4.9 days of hospitalization, p=ns). Renal function improvement during hospitalization and 30 days after discharge did not differ significantly between the two groups. Patients that received L/R showed a higher increase in plasma HCO3 (ΔHCO3) concentration at discharge than those that received N/S 0.9% (4.9 ± 4.1 vs 2.46 ± 3.7 meq/l, p=ns) and pH increase (ΔpH) was slightly higher in those that received L/R solution (0.052 ± 0.066 vs 0.023 ± 0.071, p=ns). Patients treated with N/S 0.9% showed a greater decrease in serum potassium (ΔK) at discharge compared to those treated with L/R (-0.39 ± 1.03 vs -0.17 ± 0.43 meq/l, p=ns, respectively). No patient received acute dialysis treatment. Conclusion Administration of L/R solution as a hydration treatment to patients with prerenal AKI and established CKD is not inferior concerning safety and efficacy to N/S 0.9% solution. In addition, L/R administration seems to marginally improve acid-base balance in this specific group of patients.

Management of Acute Kidney Injury and Acid-Base Balance in the Septic Patient

2016 ◽  
Vol 37 (2) ◽  
pp. 277-288 ◽  
Author(s):  
Paul D. Weyker ◽  
Xosé L. Pérez ◽  
Kathleen D. Liu
Keyword(s):  
Acute Kidney Injury ◽  
Septic Patient ◽  
Kidney Injury ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance

Could Solutions Low in Glucose Degradation Products Preserve Residual Renal Function in Incident Peritoneal Dialysis Patients? A 1-Year Multicenter Prospective Randomized Controlled Trial (Balnet Study)

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 117-122 ◽  
Author(s):  
Sung Gyun Kim ◽  
Sejoong Kim ◽  
Young-Hwan Hwang ◽  
Kiwon Kim ◽  
Ji Eun Oh ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Repeated Measures ◽  
Degradation Products ◽  
Residual Renal Function ◽  
Acid Base Balance ◽  
Acid Base ◽  
Glucose Degradation Products ◽  
Significant Difference ◽  
Base Balance

⋄ Objectives In vitro studies of peritoneal dialysis (PD) solutions demonstrated that a lactate-buffered fluid with neutral pH and low glucose degradation products (LF) has better biocompatibility than a conventional acidic lactate-buffered fluid (CF). However, few clinical trials have evaluated the long-term benefit of the biocompatible solution on residual renal function (RRF). To compare LF with CF, we performed a prospective, randomized study with patients starting PD. ⋄ Patients and Methods After 1-month run-in period, 91 new PD patients were randomized for 12 months of treatment with either LF (Balance: Fresenius Medical Care, Bad Homburg, Germany; n = 48) or CF (Stay•Safe: Fresenius; n = 43). We measured RRF, acid–base balance, peritoneal equilibration test, and adequacy of dialysis every 6 months after the run-in period. ⋄ Results After 12 months of treatment, the residual glomerular filtration rate (GFR) in patients using LF tended to be higher than that of patients on CF ( p = 0.057 by repeated-measures analysis of variance). We observed a significant difference in the changes of residual GFR between the two groups ( p = 0.009), a difference that was especially marked in the subgroup whose baseline residual GFR was more than 2 mL/min/1.73 m2. In addition, serum total CO2 levels were higher ( p = 0.001) and serum anion gap was lower ( p = 0.019) in the LF group. We observed no differences between groups for Kt/V, C-reactive protein, or normalized protein equivalent of nitrogen appearance. ⋄ Conclusions In incident PD patients with significant residual GFR, LF may better preserve RRF over a 12-month treatment period. Additionally, pH-neutral PD fluid may improve acid–base balance as compared with CF.

Renal function and acid-base balance in the toad Bufo marinus during short-term dehydration

1986 ◽  
Vol 64 (5) ◽  
pp. 1054-1057 ◽  
Author(s):  
B. L. Tufts ◽  
D. P. Toews
Keyword(s):  
Renal Function ◽  
Bufo Marinus ◽  
Ambient Water ◽  
Acid Base Balance ◽  
Acid Base ◽  
Short Term ◽  
Base Balance ◽  
Toad Bufo ◽  
Normal Acid ◽  
Tubular Component

Specimens of Bufo marinus (L.) were cannulated in both ureters to partition between the regulatory contributions of the kidney and urinary bladder. These bladder-bypassed animals were then exposed to 10 h of dehydration in air and renal function and acid–base balance were assessed. The results indicated that the kidney showed an almost immediate response to dehydration which consisted of a large glomerular and smaller tubular component. Bypassing and emptying of the bladder and the removal of the ambient water had no effect on the animal's ability to maintain normal acid–base balance.

Dose-related effects of metformin on acid–base balance and renal function in patients with diabetes who develop acute renal failure: a cross-sectional study

2016 ◽  
Vol 53 (4) ◽  
pp. 551-558 ◽  
Author(s):  
David Cucchiari ◽  
Manuel Alfredo Podestà ◽  
Elisa Merizzoli ◽  
Albania Calvetta ◽  
Emanuela Morenghi ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acid Base Balance ◽  
Acid Base ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Base Balance

scholarly journals Intravenous Fluids and Acute Kidney Injury

2017 ◽  
Vol 43 (1-3) ◽  
pp. 163-172 ◽  
Author(s):  
Xiaoqiang Ding ◽  
Zhen Cheng ◽  
Qi Qian
Keyword(s):  
Acute Kidney Injury ◽  
Journal Club ◽  
Fluid Management ◽  
Kidney Injury ◽  
Urine Concentration ◽  
Dependent Manner ◽  
Acid Base Balance ◽  
Endothelial Surface ◽  
Base Balance ◽  
Energy Dependent

Over 50% of the human body is comprised of fluids that are distributed in defined compartments. Although compartmentalized, these fluids are dynamically connected. Fluids, electrolytes, and acid-base balance in each compartment are tightly regulated, mostly in an energy-dependent manner to achieve their designed functions. For over a century, our understanding of the microvascular fluid homeostasis has evolved from hypothesized Ernest Starling principle to evidence-based and the revised Starling principle, incorporating the functional endothelial surface layer. The kidney is a highly vascular and encapsulated organ that is exquisitely sensitive to inadequate (insufficient or excess) blood flow. The kidney is particularly sensitive to venous congestion, and studies show that reduced venous return triggers a greater degree of kidney damage than that from lacking arterial flow. Thus, fluid overload can induce severe and sustained kidney injury. In the setting of established acute kidney injury, fluid management can be challenging. Impaired capacity of urine output and urine concentration and dilution should be taken into consideration when designing fluid therapy. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452702.

Continuous Peritoneal Dialysis Compared with Daily Hemodialysis in Patients with Acute Kidney Injury

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 62-71 ◽  
Author(s):  
Daniela Ponce Gabriel ◽  
Jacqueline Teixeira Caramori ◽  
Luis Cuadrado Martin ◽  
Pasqual Barretti ◽  
Andre Luis Balbi
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Survival Rate ◽  
Acute Tubular Necrosis ◽  
Kidney Injury ◽  
Acid Base ◽  
Tubular Necrosis ◽  
Daily Hemodialysis ◽  
Continuous Peritoneal Dialysis

Background In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI. Methods A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid–base, and fluid controls were secondary endpoints. Results Of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 ± 19.8 years vs 62.5 ± 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 ± 0.2 vs 0.66 ± 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 ± 8.9 vs 24.1 ± 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 ± 33.6 mg/dL vs 112.6 ± 36.8 mg/dL)], and creatinine (5.85 ± 1.9 mg/dL vs 5.95 ± 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 ± 0.61, and in G2, it was 4.76 ± 0.65 ( p < 0.01). The two groups were similar in metabolic and acid–base control (after 4 sessions, BUN < 55 mg/dL: 46 ± 18.7 mg/dL vs 52 ± 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 ± 8.9 mEq/L vs 22.2 ± 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%). Conclusion High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI.

Acid-base balance and renal function following total body perfusion

1962 ◽  
Vol 61 (2) ◽  
pp. 287-288
Author(s):  
James G. Calene ◽  
William H. Weidman ◽  
Khalil G. Wakim ◽  
John W. Rosevear ◽  
John W. Kirklin ◽  
...  
Keyword(s):  
Renal Function ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance ◽  
Total Body
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