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- Title
Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.
- Authors
Vaara, Suvi T.; Ostermann, Marlies; Bitker, Laurent; Schneider, Antoine; Poli, Elettra; Hoste, Eric; Fierens, Jan; Joannidis, Michael; Zarbock, Alexander; van Haren, Frank; Prowle, John; Selander, Tuomas; Bäcklund, Minna; Pettilä, Ville; Bellomo, Rinaldo; on behalf of the REVERSE-AKI study team; Vaara, Suvi; Eastwood, Glenn; Byrne, Liam; Nourse, Mary
- Abstract
<bold>Purpose: </bold>We compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation.<bold>Methods: </bold>This multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization.<bold>Results: </bold>Mean (SD) cumulative fluid balance at 72 h from randomization was - 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) - 1148 mL (- 2200 to - 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference - 1.0 [- 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm.<bold>Conclusions: </bold>In critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified.
- Subjects
EUROPE; AUSTRALIA; ACUTE kidney failure; CRITICALLY ill patient care; KIDNEY transplantation; WATER-electrolyte balance (Physiology); RENAL replacement therapy; PILOT projects; RESEARCH; FLUID therapy; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; CATASTROPHIC illness; COMPARATIVE studies
- Publication
Intensive Care Medicine, 2021, Vol 47, Issue 6, p665
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-021-06401-6