Acute kidney injury amid a national shortage of intravenous fluids: A before-and-after study

Introduction

Hurricane Helene in 2024 resulted in a sudden shortage of intravenous (IV) fluids across the US, activating hospital strategies to limit fluid utilization. The clinical impact of this shortage remains unclear. This study aims to describe the effect of fluid conservation strategies on acute kidney injury (AKI) rates during a hospital response.

Methods

This is a single-center retrospective study of patients undergoing major surgery during five weeks of IV fluid shortage from September to October 2024. Patients were categorized into groups per week, using the week before the IV fluid shortage as the control group (T1). The primary outcome was acute kidney injury (AKI) within seven days post-surgery, defined by KDIGO criteria. A multivariable logistic regression assessed the association between each phase and AKI, adjusting for confounders.

Results

The study had 503 patients in 5 weeks (T1: 108, T2: 127, T3: 92, T4: 99, T5:77). Baseline characteristics were similar across groups. AKI occurred in 2.8 % of T1, 3.9 % of T2 (OR 1.88, 95 % CI 0.40–8.89, P = 0.424), 6.5 % of T3 (OR 3.53, 95 % CI 0.77–16.3, P = 0.105), 5.1 % of T4 (OR 1.45, 95 % CI 0.31–6.84, P = 0.638), and 3.9 % of T5 (OR 1.36, 95 % CI 0.25–7.35, P = 0.720). All groups had a higher AKI rate than T1, suggesting a possible clinical difference without reaching statistical significance.

Conclusions

Emergency reduction strategies were associated with maintaining patient safety. While findings suggest an impact of fluid conservation measures on AKI incidence, it was not statistically significant. Extensive studies are needed to confirm these findings.