Fluid management in sepsis associated acute kidney injury

Sepsis-associated acute kidney injury (SA-AKI) significantly contributes to morbidity and mortality in critically ill patients, necessitating an evidence-based approach to fluid management. Understanding the pathophysiology of SA-AKI and appreciation of the delicate balance between adequate fluid resuscitation and prevention of fluid overload, are essential to deliver optimal management of these patients.

This review highlights the phases of fluid therapy, the strategies for fluid management in SA-AKI, the types of preferred fluids in different phases, and both, pharmacologic and mechanical methods of fluid removal. The application of individualised strategies tailored to specific patient subsets, including those with septic cardiomyopathy or chronic kidney disease remains challenging. A major limitation is that most fluid studies were conducted in critically ill patients in general, rather than patients with SA-AKI. Future research is imperative to study fluid management specifically in SA-AKI, refine therapeutic protocols and guide management to improve patient outcomes.