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Fluids are GOOD. Fluids & AKI. Volume overload is BAD. UGLY Fluids cause AKI. N Engl J Med 2004. EGDT: fluids are good & prevent AKI. Lin et al, Shock 2006. Phase-contrast MRI 10 septic AKI patients 11 normal volunteers . RRT: 9 Anuria: 3 CrCl>60 mL/min: 2. RF in non AKI.
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Fluids are GOOD Fluids & AKI Volume overload is BAD UGLY Fluids cause AKI
EGDT: fluids are good & prevent AKI Lin et al, Shock 2006
Phase-contrast MRI 10 septic AKI patients 11 normal volunteers RRT: 9 Anuria: 3 CrCl>60 mL/min: 2 RF in non AKI Prowle et al Crit Care Med 2012
Renal Plasma Flow and GFR Systematic review Human studies 22 articles 250 patients Prowle et al. Renal Failure 2010
RBF decreased in sepsis and early AKI? 7 Sheep E. Coli infusion Langenberg et al. Kidney Int 2006
EGDT and AKI Prowle et al. Crit Care 2012
Fluids are GOOD Fluids & AKI Volume overload is BAD UGLY Fluids cause AKI
Fluid bolus? The FEAST trial N = 3141 children Severe infection Maitland et al. NEJM 2011
PRCT N = 1000 Wiedemann, N Engl J Med 2006
Fluid-Management in ARDS Wiedemann et al. N Engl J Med 2006
Venous pressure & ↘ renal bloodflow Winton, J Physiol 1931
AKI & CVP, CI, systolic BP, & PCWP CVP CI SBP PCWP Mullens et al. JACC 2009
AKI & CVP, CI, systolic BP, & PCWP CVP CI SBP PCWP Mullens et al. JACC 2009
Volume and outcome in AKI-RRT Bouchard et al. KI 2009, Payen et al. Crit Care 2008, Grams et al. CJASN 2011, Vaara et al. Crit Care 2012
Negative FB during CRRT is good Bellomo et al. Crit Care Med 2012
Negative FB during CRRT is good Bellomo et al. Crit Care Med 2012
Summary Recent PRCT’s HES Magder et al Crit Care Med 2010, James et al. J Trauma 2011, Guidet et al. Crit Care 2012, Perner et al. NEJM 2012, Myburgh et al. NEJM 2012
AKI after gelatin MVR adjusted Risk for AKI after >33mL/kg GEL: OR 1.99 (1.05-3.79) HES: OR 1.85 (1.01 – 3.41) Observational N = 1383 HES N = 1528 GEL Schabinski et al. Intensive Care Med 2009
Saline vs. Plasmalyte ®? N = 30,994 vs. 926 Major abd surgery • Saline = More complications and use of resources: • Major infection • Dialysis • Blood transfusions • Electrolyte disturbances Shaw et al. Ann Surg 2012
Chloride liberal/restrictive fluid therapy AKI stage 2-3 Yunos et al. JAMA 2012
Take home messages Fluids and AKI: just enough! • Not too little • Not too much Fluids and AKI: beware for the ugly.
Thank you for your attention! Eric.hoste@ugent.be
To pee or not to pee: Fluids & AKI Eric Hoste MD, PhD Ghent University Hospital
CHEST: HES 130/0.4 vs. Saline HES Saline Myburgh et al. NEJM 2012
CHEST: HES 130/0.4 vs. Saline HES Saline Myburgh et al. NEJM 2012
