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Intensive Care Med. 2017 Jun;43(6):807-815. doi: 10.1007/s00134-017-4817-x. Epub 2017 May 3.

Fluid management in acute kidney injury.

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Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, William Harvey Research Institute, Queen Mary University of London, London, UK.
Division of Intensive Care and Emergency Medicine, Medical University Innsbruck, Innsbruck, Austria.
Intensive Care Unit, Medical Research Institute of New Zealand, Wellington Hospital, Wellington, New Zealand.
Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.


Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI.


Acute kidney injury; Critical Care; Fluid; Intravenous fluid; Kidney failure; Renal failure; Sepsis; Shock

[Indexed for MEDLINE]

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