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Fluids & AKI

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 & AKI

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  1. Fluids are GOOD Fluids & AKI Volume overload is BAD UGLY Fluids cause AKI

  2. N Engl J Med 2004

  3. EGDT: fluids are good & prevent AKI Lin et al, Shock 2006

  4. 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

  5. Renal Plasma Flow and GFR Systematic review Human studies 22 articles 250 patients Prowle et al. Renal Failure 2010

  6. RBF decreased in sepsis and early AKI? 7 Sheep E. Coli infusion Langenberg et al. Kidney Int 2006

  7. EGDT and AKI Prowle et al. Crit Care 2012

  8. Fluids are GOOD Fluids & AKI Volume overload is BAD UGLY Fluids cause AKI

  9. Fluid bolus? The FEAST trial N = 3141 children Severe infection Maitland et al. NEJM 2011

  10. PRCT N = 1000 Wiedemann, N Engl J Med 2006

  11. Fluid-Management in ARDS Wiedemann et al. N Engl J Med 2006

  12. Venous pressure & ↘ renal bloodflow Winton, J Physiol 1931

  13. AKI & CVP, CI, systolic BP, & PCWP CVP CI SBP PCWP Mullens et al. JACC 2009

  14. AKI & CVP, CI, systolic BP, & PCWP CVP CI SBP PCWP Mullens et al. JACC 2009

  15. 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

  16. Negative FB during CRRT is good Bellomo et al. Crit Care Med 2012

  17. Negative FB during CRRT is good Bellomo et al. Crit Care Med 2012

  18. Fluids & AKI

  19. 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

  20. 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

  21. PRCT’s on albumin

  22. 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

  23. Chloride liberal/restrictive fluid therapy AKI stage 2-3 Yunos et al. JAMA 2012

  24. Take home messages Fluids and AKI: just enough! • Not too little • Not too much Fluids and AKI: beware for the ugly.

  25. Thank you for your attention! Eric.hoste@ugent.be

  26. Fluids & AKI

  27. To pee or not to pee: Fluids & AKI Eric Hoste MD, PhD Ghent University Hospital

  28. CHEST: HES 130/0.4 vs. Saline HES Saline Myburgh et al. NEJM 2012

  29. CHEST: HES 130/0.4 vs. Saline HES Saline Myburgh et al. NEJM 2012

  30. Perner et al. NEJM 2012

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