Effect of restrictive fluid balance in critically ill patients with acute kidney injury: a target trial emulation
Main finding · AKI RankResult — go to the resultMean difference - 0.8 95% CI - 1.3 to - 0.3Authors' conclusion
Restrictive fluid management was associated with improved renal function in early AKI but potentially harmful effects in stages 2 and 3 AKI.
Study context
- Population
- Critically ill adults with acute kidney injury (AKI) within 72 h of intensive care unit (ICU) admission and AKI-Fluid Balance Risk Score ≥ 32, 12 ICUs in Queensland, Australia (2015–2021)
- Participants
- 8,685 adults
- Exposure
- Restrictive fluid management vs usual fluid management
- Outcome
- AKI Rank
- Follow-up
- Day 7
Methodological detailsobservational cohort study, multicentre, per-protocol effects, sequential doubly robust estimator for longitudinal modified treatment policies, Effective sample sizes limited (7-16%), indicating reliance on extrapolation
- Observational cohort study
- Multicentre
- Per-protocol effects
- Sequential doubly robust estimator for longitudinal modified treatment policies
- Effective sample sizes limited (7-16%), indicating reliance on extrapolation
Main finding
As reported in the abstract
Mean difference
- 0.8
95% CI - 1.3 to - 0.3
Observational data: associations, not effects.
Secondary outcomes
AKI Rank (stage 2 AKI subgroup)
| Mean difference (95% CI) | ||
|---|---|---|
| InterventionWorse outcomes · heterogeneity by AKI stage | 4.5 (3.8–5.1) | |
| −50510Difference (linear scale) |
AKI Rank (stage 3 AKI subgroup)
| Mean difference (95% CI) | ||
|---|---|---|
| InterventionWorse outcomes · heterogeneity by AKI stage | 6.3 (4.7–7.9) | |
| −50510Difference (linear scale) |
30-day mortality (stage 2 and 3 AKI)
| RR (95% CI) | ||
|---|---|---|
| InterventionIncreased mortality | 1.20 (1.09–1.33) | |
| 0.512Relative risk (log scale) |
| Outcome | Estimate |
|---|---|
| Fluid balance · 72 hSubstantial reduction | difference - 2,304 mL (95% CI - 2,465 to - 2,144) |
| AKI Rank (stage 1 AKI subgroup)Improved renal function · heterogeneity by AKI stage | mean difference - 3.1 (95% CI - 3.8 to - 2.5) |
- 30-day mortality (stage 2 and 3 AKI): effective sample sizes limited (7-16%), reliance on extrapolation
Original publication
Effect of restrictive fluid balance in critically ill patients with acute kidney injury: a target trial emulation. Crit Care. Published 30 May 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →