Research state of early fluid resuscitation and volume management in sepsis⁃associated acute kidney injury

Abstract

"Sepsis ⁃ associated acute kidney injury（SA ⁃ AKI）is a common and serious complication in patients with sepsis. Its pathogenesis is complex，involving multiple pathophysiological processes such as immune dysregulation，microcirculatory disturbances ，and energy metabolism imbalances ，with a clinical mortality rate of 35% to 67%.Current treatment strategies focus on early fluid resuscitation and precise volume management，although there is still controversy regarding these approaches. Research has shown that crystalloid fluids（especially balanced electrolyte solutions）may reduce the incidence and short⁃term mortality of SA⁃AKI. However，large⁃scale randomized controlled trials have not demonstrated significant differences compared to normal saline. Albumin，as a colloid solution，may improve tissue perfusion，but its concentration choices and suitable patient populations still require further verification.Hydroxyethyl starch and dextran injections have not been recommended due to safety concerns. In terms of volume management，traditional goal ⁃ directed fluid resuscitation（such as the 30 mL/kg fluid infusion）lacks clear survival benefits. However，fluid overload is closely related to adverse outcomes. Restrictive fluid strategies may reduce the risk of renal congestion but can increase the need for vasopressor drugs. Existing evidence does not support strictly limiting the initial resuscitation volume. Point⁃of⁃care ultrasound techniques offer a non⁃invasive tool for dynamically assessing venous congestion status（such as VExUS scoring），potentially reducing the risk of SA⁃AKI through optimized fluid management.Future approaches should combine biomarkers with multimodal monitoring to create individualized fluid management plans，balancing the need for early resuscitation against the risks of volume overload，to improve outcomes for patients with SA⁃AKI. This article provides a brief review on fluid resuscitation and volume management in SA⁃AKI patients.