Fluid management in acute kidney injury: from evaluating fluid responsiveness towards assessment of fluid tolerance.

Autor:	Argaiz ER; Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico., Rola P; Intensive Care Unit, Santa Cabrini Hospital, Montréal, QC, Canada., Haycock KH; Department of Emergency Medicine, Loma Linda University Health, Loma Linda, CA, USA., Verbrugge FH; Centre for Cardiovascular Diseases, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium.; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
Jazyk:	angličtina
Zdroj:	European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2022 Nov 02; Vol. 11 (10), pp. 786-793.
DOI:	10.1093/ehjacc/zuac104
Abstrakt:	Despite the widespread use of intravenous fluids in acute kidney injury (AKI), solid evidence is lacking. Intravenous fluids mainly improve AKI due to true hypovolaemia, which is difficult to discern at the bedside unless it is very pronounced. Empiric fluid resuscitation triggered only by elevated serum creatinine levels or oliguria is frequently misguided, especially in the presence of fluid intolerance syndromes such as increased extravascular lung water, capillary leak, intra-abdominal hypertension, and systemic venous congestion. While fluid responsiveness tests clearly identify patients who will not benefit from fluid administration (i.e. those without an increase in cardiac output), the presence of fluid responsiveness does not guarantee that fluid therapy is indicated or even safe. This review calls for more attention to the concept of fluid tolerance, incorporating it into a practical algorithm with systematic venous Doppler ultrasonography assessment to use at the bedside, thereby lowering the risk of detrimental kidney congestion in AKI. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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