Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.

Content Provider	Europe PMC
Author	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
Abstract	PurposeWe compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation.MethodsThis 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.ResultsMean (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.ConclusionsIn 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.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-021-06401-6.
ISSN	03424642
Journal	Intensive Care Medicine
Volume Number	47
PubMed Central reference number	PMC8195764
Issue Number	6
PubMed reference number	33961058
e-ISSN	14321238
DOI	10.1007/s00134-021-06401-6
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2021-05-07
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/. © The Author(s) 2021
Subject Keyword	Acute kidney injury Critically ill Fluid balance Restrictive fluid management
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine