Effect of restrictive fluid resuscitation on severe acute kidney injury in septic shock: a systematic review and meta-analysis
A meta-analysis of nine randomized trials (3,718 patients) found that a restrictive fluid-resuscitation strategy modestly reduced the incidence of severe acute kidney injury in sepsis-associated hypotension and shock compared with liberal fluids.
Study design
Systematic review and random-effects meta-analysis (GRADE approach) of randomized trials comparing restrictive versus liberal fluid resuscitation in adults with sepsis-associated hypotension or shock, with severe AKI (AKIN stage 2-3 or KDIGO stage 2-3) as the outcome; databases were searched through November 2024.
Key findings
Nine trials with 3,718 participants showed a significant reduction in severe AKI with restriction (RR 0.87, 95% CI 0.79-0.96; I2=0%) and a shorter duration of mechanical ventilation. Trial sequential analysis met the required information size, and GRADE certainty was moderate-to-high for the AKI outcome.
Clinical implications
A restrictive fluid strategy appears superior to usual liberal resuscitation for limiting severe AKI in septic shock, supporting more conservative fluid targets after initial resuscitation, while substantial heterogeneity in some secondary outcomes warrants caution.
Category
Research
Source
BMJ Open
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.