Fluid and electrolyte management in renal disorders: Best practices in nephrology: Review article

Fayez Abdullah Hussain Alsarimi; Sultan Sulaiman Alharbi; Sultan Mohammed Algfari; Ahmed Ibrahim Alahmad; Mshaweh Mohammed Alshammry; Naif Saad Alqahtani; Shayem Hamdan Alharbi; ‎‏Zaid Helal Alanazi; Hamad Marshud Alotaibi; Bander Khalid Baurasien; Mohammed Hamoud Alwaked; Mohammed Mesfer Musaed Al Khathami; Bander Batti Alrasheedi; ‏Abdulaziz Ahmad Alrashidi

doi:10.53730/ijhs.v1nS1.15157

Authors

Fayez Abdullah Hussain Alsarimi KSA, National Guard Health Affairs
Sultan Sulaiman Alharbi KSA, National Guard Health Affairs
Sultan Mohammed Algfari KSA, National Guard Health Affairs
Ahmed Ibrahim Alahmad KSA, National Guard Health Affairs
Mshaweh Mohammed Alshammry KSA, National Guard Health Affairs
Naif Saad Alqahtani KSA, National Guard Health Affairs
Shayem Hamdan Alharbi KSA, National Guard Health Affairs
‎‏Zaid Helal Alanazi KSA, National Guard Health Affairs
Hamad Marshud Alotaibi KSA, National Guard Health Affairs
Bander Khalid Baurasien KSA, National Guard Health Affairs
Mohammed Hamoud Alwaked KSA, National Guard Health Affairs
Mohammed Mesfer Musaed Al Khathami KSA, National Guard Health Affairs
Bander Batti Alrasheedi KSA, National Guard Health Affairs
‏Abdulaziz Ahmad Alrashidi KSA, National Guard Health Affairs

Keywords:

renal disorders, fluid management, electrolyte balance, acute kidney injury, chronic kidney disease, hydration assessment, fluid therapy

Abstract

Background: The kidneys play a vital role in maintaining fluid, electrolyte, and acid-base balance. Disruptions in these functions are seen in both acute kidney injury (AKI) and chronic kidney disease (CKD). Effective management of fluid and electrolytes is crucial for patient outcomes in renal disorders. Aim: This review article aims to consolidate best practices in fluid and electrolyte management for patients with renal disorders, focusing on acute and chronic conditions. Also, to assist the roles for healthcare providers. Methods: A comprehensive review of current literature and clinical guidelines was conducted to outline fluid and electrolyte management strategies. Key areas covered include fluid therapy, hydration assessment, and the use of different fluid types and administration routes. Results: The review highlights that individualized fluid therapy is essential for both AKI and CKD patients. Accurate assessment of hydration status is critical, with various methods discussed. Intravenous fluid administration is preferred in hospitalized patients, though alternatives like intraosseous and subcutaneous routes are also noted. Balanced polyionic solutions are recommended for initial resuscitation, while dextrose solutions are used for maintenance. The review also emphasizes the importance of cautious fluid administration to prevent overhydration and its associated risks.

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References

Wellman, M. L., DiBartola, S. P., & Kohn, C. W. (2012). Applied physiology of body fluids in dogs and cats. In S. DiBartola (Ed.), Fluid, electrolyte, and acid-base disorders in small animal practice (4th ed., pp. 2–25). Elsevier. DOI: https://doi.org/10.1016/B978-1-4377-0654-3.00008-1

Worwag, S., & Langston, C. E. (2008). Feline acute intrinsic renal failure: 32 cats (1997-2004). Journal of the American Veterinary Medical Association, 232(5), 728–732. DOI: https://doi.org/10.2460/javma.232.5.728

Behrend, E., Grauer, G. F., Mani, I., & others. (1996). Hospital-acquired acute renal failure in dogs: 29 cases (1983-1992). Journal of the American Veterinary Medical Association, 208, 537–541. DOI: https://doi.org/10.2460/javma.1996.208.04.537

Kirby, R., & Rudloff, E. (2005). Crystalloid and colloid fluid therapy. In S. J. Ettinger & E. C. Feldman (Eds.), Textbook of veterinary internal medicine (6th ed., pp. 412–424). Elsevier Saunders.

Cowgill, L. D., & Francey, T. (2005). Acute uremia. In S. J. Ettinger & E. C. Feldman (Eds.), Textbook of veterinary internal medicine (6th ed., pp. 1731–1751). Elsevier Saunders.

Mathews, K. A. (2006). Monitoring fluid therapy and complications of fluid therapy. In S. P. DiBartola (Ed.), Fluid, electrolyte, and acid-base disorders in small animal practice (3rd ed., pp. 377–391). Saunders Elsevier. DOI: https://doi.org/10.1016/B0-72-163949-6/50019-9

Chew, D. J., & Gieg, J. A. (2006). Fluid therapy during intrinsic renal failure. In S. P. DiBartola (Ed.), Fluid, electrolyte, and acid-base disorders in small animal practice (3rd ed., pp. 518–540). Saunders Elsevier. DOI: https://doi.org/10.1016/B0-72-163949-6/50025-4

Syme, H. M., Barber, P. J., Markwell, P. J., & others. (2002). Prevalence of systolic hypertension in cats with chronic renal failure at initial evaluation. Journal of the American Veterinary Medical Association, 220, 1799–1804. DOI: https://doi.org/10.2460/javma.2002.220.1799

Jacob, F., Polzin, D. J., Osborne, C. A., & others. (2003). Association between initial systolic blood pressure and risk of developing a uremic crisis or of dying in dogs with chronic renal failure. Journal of the American Veterinary Medical Association, 222, 322–329. DOI: https://doi.org/10.2460/javma.2003.222.322

Marik, P., Barram, M., & Vahid, B. (2008). Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest, 134, 172–178. DOI: https://doi.org/10.1378/chest.07-2331

Davison, D. L., Patel, K., & Chawla, L. S. (2012). Hemodynamic monitoring in the critically ill: Spanning the range of kidney function. American Journal of Kidney Diseases, 59, 715–723. DOI: https://doi.org/10.1053/j.ajkd.2011.12.016

Cazzolli, D., & Prittie, J. (2015). The crystalloid-colloid debate: Consequences of resuscitation fluid selection in veterinary critical care. Journal of Veterinary Emergency and Critical Care (San Antonio), 25, 6–19. DOI: https://doi.org/10.1111/vec.12281

Cavanagh, A. A., Sullivan, L. A., & Hansen, B. D. (2016). Retrospective evaluation of fluid overload and relationship to outcome in critically ill dogs. Journal of Veterinary Emergency and Critical Care (San Antonio), 26, 578–586. DOI: https://doi.org/10.1111/vec.12477

Prowle, J. R., Kirwan, C. J., & Bellomo, R. (2014). Fluid management for the prevention and attenuation of acute kidney injury. Nature Reviews Nephrology, 10, 37–47. DOI: https://doi.org/10.1038/nrneph.2013.232

Myburgh, J. A., Finfer, S., Bellomo, R., & others. (2012). Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New England Journal of Medicine, 367(20), 1901–1911. DOI: https://doi.org/10.1056/NEJMoa1209759

Guidet, B., Martinet, O., Boulain, T., & others. (2012). Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study. Critical Care, 16, R94. DOI: https://doi.org/10.1186/cc11358

Cohn, L. A., Kerl, M. E., Lenox, C. E., & others. (2007). Response of healthy dogs to infusions of human serum albumin. American Journal of Veterinary Research, 68, 657–663. DOI: https://doi.org/10.2460/ajvr.68.6.657

Francis, A. H., Martin, L. G., Haldorson, G. J., & others. (2007). Adverse reactions suggestive of type III hypersensitivity in six healthy dogs given human albumin. Journal of the American Veterinary Medical Association, 230, 873–879. DOI: https://doi.org/10.2460/javma.230.6.873

Prowle, J. R., Echeverri, J. E., Ligabo, E. V., & others. (2010). Fluid balance and acute kidney injury. Nature Reviews Nephrology, 6, 107–115. DOI: https://doi.org/10.1038/nrneph.2009.213

Goldstein, S. L. (2014). Fluid management in acute kidney injury. Journal of Intensive Care Medicine, 29, 183–189. DOI: https://doi.org/10.1177/0885066612465816

Waddell, L. S. (2005). Hypotension. In S. J. Ettinger & E. C. Feldman (Eds.), Textbook of veterinary internal medicine (6th ed., pp. 480–483). Elsevier Saunders.

Otto, C. M. (2005). Shock. In S. J. Ettinger & E. C. Feldman (Eds.), Textbook of veterinary internal medicine (6th ed., pp. 455–457). Saunders Elsevier.

Lin, S. M., Huang, C. D., & Lin, H. C. (2006). A modified goal-directed protocol improves clinical outcomes in intensive care unit patients with septic shock: A randomized controlled trial. Shock, 26, 551–557. DOI: https://doi.org/10.1097/01.shk.0000232271.09440.8f

Prowle, J. R., & Bellomo, R. (2013). Fluid administration and the kidney. Current Opinion in Critical Care, 19, 308–314. DOI: https://doi.org/10.1097/MCC.0b013e3283632e29

Prowle, J. R., & Bellomo, R. (2010). Fluid administration and the kidney. Current Opinion in Critical Care, 16, 332–336. DOI: https://doi.org/10.1097/MCC.0b013e32833be90b

Sutherland, S. M., Zappitelli, M., Alexander, S. R., & others. (2010). Fluid overload and mortality in children receiving continuous renal replacement therapy: The prospective pediatric continuous renal replacement therapy registry. American Journal of Kidney Diseases, 55, 316–325. DOI: https://doi.org/10.1053/j.ajkd.2009.10.048

Conger, J. D. (2001). Vascular alterations in acute renal failure: Roles in initiation and maintenance. In B. A. Molitoris & W. F. Finn (Eds.), Acute renal failure: A companion to Brenner & Rector’s the kidney (pp. 13–29). W.B. Saunders.

Mehta, R. L., Pascual, M. T., Soroko, S., & others. (2002). Diuretics, mortality, and nonrecovery of renal function in acute renal failure. Journal of the American Medical Association, 288, 2547–2553. DOI: https://doi.org/10.1001/jama.288.20.2547

Finn, W. F. (2001). Recovery from acute renal failure. In B. A. Molitoris & W. F. Finn (Eds.), Acute renal failure: A companion to Brenner & Rector’s the kidney (pp. 425–450). W.B. Saunders.

Better, O. S., Rubinstein, I., Winaver, J. M., & others. (1997). Mannitol therapy revisited (1940-1997). Kidney International, 51, 866–894. DOI: https://doi.org/10.1038/ki.1997.409

McClellan, J. M., Goldstein, R. E., Erb, H. N., & others. (2006). Effects of administration of fluids and diuretics on glomerular filtration rate, renal blood flow, and urine output in healthy awake cats. American Journal of Veterinary Research, 67, 715–722. DOI: https://doi.org/10.2460/ajvr.67.4.715

Ross, L. R. (1989). Fluid therapy for acute and chronic renal failure. Veterinary Clinics of North America: Small Animal Practice, 19, 343–359. DOI: https://doi.org/10.1016/S0195-5616(89)50034-2

De Vriese, A. S. (2003). Prevention and treatment of acute renal failure in sepsis. Journal of the American Society of Nephrology, 14, 792–805. DOI: https://doi.org/10.1097/01.ASN.0000055652.37763.F7

Vijayan, A., & Miller, S. B. (1998). Acute renal failure: Prevention and nondialytic therapy. Seminars in Nephrology, 18, 523–532.

Nolan, C. R., & Anderson, R. J. (1998). Hospital-acquired acute renal failure. Journal of the American Society of Nephrology, 9, 710–718. DOI: https://doi.org/10.1681/ASN.V94710

Shilliday, I. R., Quinn, K. J., & Allison, M. E. M. (1997). Loop diuretics in the management of acute renal failure: A prospective, double-blind, placebo-controlled, randomized study. Nephrology Dialysis Transplantation, 12, 2592–2596. DOI: https://doi.org/10.1093/ndt/12.12.2592

Heyman, S. N., Rosen, S., Epstein, F. H., & others. (1994). Loop diuretics reduce hypoxic damage to proximal tubules of the isolated perfused rat kidney. Kidney International, 45, 981–985. DOI: https://doi.org/10.1038/ki.1994.132

Pruchnicki, M. C., & Dasta, J. F. (2002). Acute renal failure in hospitalized patients: Part II. Annals of Pharmacotherapy, 36, 1430–1442. DOI: https://doi.org/10.1345/1542-6270(2002)036<1430:ARFIHP>2.0.CO;2

Martin, S. J., & Danziger, L. H. (1994). Continuous infusion of loop diuretics in the critically ill: A review of the literature. Critical Care Medicine, 22, 1323–1329. DOI: https://doi.org/10.1097/00003246-199408000-00017

Adin, D. B., Taylor, A. W., Hill, R. C., & others. (2003). Intermittent bolus injection versus continuous infusion of furosemide in normal adult greyhound dogs. Journal of Veterinary Internal Medicine, 17, 632–636. DOI: https://doi.org/10.1111/j.1939-1676.2003.tb02493.x

Adin, D. B., Hill, R. C., & Scott, K. C. (2003). Short-term compatibility of furosemide with crystalloid solutions. Journal of Veterinary Internal Medicine, 17, 724–726. DOI: https://doi.org/10.1111/j.1939-1676.2003.tb02508.x

Bellomo, R., Chapman, M., Finfer, S., & others. (2000). Low-dose dopamine in patients with early renal dysfunction: A placebo-controlled randomized trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet, 356, 2139–2143. DOI: https://doi.org/10.1016/S0140-6736(00)03495-4

Rudis, M. I. (2001). Low-dose dopamine in the intensive care unit: DNR or DNRx? Critical Care Medicine, 29, 1638–1639. DOI: https://doi.org/10.1097/00003246-200108000-00026

Sigrist, N. E. (2007). Use of dopamine in acute renal failure. Journal of Veterinary Emergency and Critical Care, 17, 117–126. DOI: https://doi.org/10.1111/j.1476-4431.2007.00225.x

Halpenny, M., Markos, F., Snow, H. M., & others. (2001). Effects of prophylactic fenoldopam infusion on renal blood flow and renal tubular function during acute hypovolemia in anesthetized dogs. Critical Care Medicine, 29, 855–860. DOI: https://doi.org/10.1097/00003246-200104000-00034

Simmons, J. P., Wohl, J. S., Schwartz, D. D., & others. (2006). Diuretic effects of fenoldopam in healthy cats. Journal of Veterinary Emergency and Critical Care, 16, 96–103. DOI: https://doi.org/10.1111/j.1476-4431.2006.00176.x

Murray, C., Markos, F., & Snow, H. M. (2003). Effects of fenoldopam on renal blood flow and its function in a canine model of rhabdomyolysis. European Journal of Anaesthesiology, 20, 711–718. DOI: https://doi.org/10.1097/00003643-200309000-00006

Mathews, K. A., & Monteith, G. (2007). Evaluation of adding diltiazem therapy to standard treatment of acute renal failure caused by leptospirosis: 18 dogs (1998-2001). Journal of Veterinary Emergency and Critical Care, 17, 149–158. DOI: https://doi.org/10.1111/j.1476-4431.2007.00232.x