Aggressive versus conservative fluid resuscitation in septic hemodialysis patients

Rajdev, Kartikeya; Leifer, Lazer; Sandhu, Gurkirat; Mann, Benjamin; Pervaiz, Sami; Lahan, Shubham; Siddiqui, Abdul Hasan; Habib, Saad; Joseph, Bino; El‐Sayegh, Suzanne

doi:10.1016/j.ajem.2020.10.037

Cited by 7 publications

(1 citation statement)

References 19 publications

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“…They have limited residual renal function and are often oligo/anuric at baseline, in conjunction with relative diuretic resistance, meaning that the therapeutic window of fluid administration is relatively narrow. However, studies suggest that early goal‐directed therapy in sepsis, for example, is safe in this group of patients [14], although ongoing monitoring and reassessment remains critical, with maintenance fluid requirements after the early resuscitation period reduced.…”

Section: Individuals With Pre‐existing Kidney Disease Presenting To T...mentioning

confidence: 99%

Renal medicine in the intensive care unit: a narrative review

et al. 2023

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Summary Kidney disease, both acute and chronic, is commonly encountered on the intensive care unit. Due to the role the kidneys play in whole body homeostasis, it follows that their dysfunction has wide‐ranging implications and can affect prescribing and therapeutic management. This narrative review discusses the pathophysiology of acute kidney injury and chronic kidney disease, and how this relates to critically unwell patients. We cover several aspects of the management of renal dysfunction on the critical care unit, exploring some of the recurrent themes within the literature, including type and timing of kidney replacement therapy, management of acute kidney injury, as well as discussing how novel biomarkers for acute kidney injury may help to identify patients suffering from acute kidney injury as well as risk stratifying these patients. We discuss how early involvement of specialist nephrology services can improve outcomes in patients with kidney disease as well as offer valuable diagnostic and specialist management advice, particularly for patients with established end stage kidney disease and patients who are already known to nephrology services. We also explore some of the ongoing research questions that need to be answered within this arena.

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Section: Individuals With Pre‐existing Kidney Disease Presenting To T...mentioning

confidence: 99%

Renal medicine in the intensive care unit: a narrative review

et al. 2023

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Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis

Pence

Tran

Shesser

et al. 2022

The American Journal of Emergency Medicine

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Fluid Resuscitation Dilemma in End-stage Renal Disease Patients Presenting with Sepsis: A Systematic Review and Meta-analysis

Khattar,

El Gharib,

Pokima

et al. 2024

J Intensive Care Med

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Background: This study aims to investigate the safety and efficacy of guideline-directed fluid resuscitation (GDFR) compared with conservative fluid management in end-stage renal disease (ESRD) patients with sepsis by evaluating 90-day mortality and intubation rate. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases using specific keywords and controlled vocabulary. The search strategy, implemented until October 1, 2023, aimed to identify studies examining fluid resuscitation in ESRD patients with sepsis. The review process was streamlined using Covidence software. A fourth reviewer resolved discrepancies in study inclusion. A random-effects model with the generic Mantel–Haenszel method was preferred for integrating odds ratios (ORs). Sensitivity analysis and publication bias analysis were performed. Results: Of the 1274 identified studies, 10 were selected for inclusion, examining 1184 patients, 593 of whom received GDFR. Four studies were selected to investigate the intubation rate, including 304 patients. No significant mortality or intubation rate difference was spotted between both groups [OR = 1.23; confidence interval (CI) = 0.92-1.65; I2 = 0% and OR = 1.91; CI = 0.91-4.04]. In most studies, sensitivity analysis using the leave-one-out approach revealed higher mortality and intubation rates. The Egger test results indicated no statistically significant publication bias across the included studies. Conclusion: Our research contradicts the common assumption about the effectiveness of GDFR for sepsis patients with ESRD. It suggests that this approach, while not superior to the conservative strategy, may potentially be harmful.

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Aggressive versus conservative fluid resuscitation in septic hemodialysis patients

Cited by 7 publications

References 19 publications

Renal medicine in the intensive care unit: a narrative review

Renal medicine in the intensive care unit: a narrative review

Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis

Fluid Resuscitation Dilemma in End-stage Renal Disease Patients Presenting with Sepsis: A Systematic Review and Meta-analysis

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