Comparative Effectiveness of Fluid Resuscitation Strategies in Preventing AKI in Critically Ill Patients: A Meta-Analysis

Background: Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. There is no clear consensus on the most suitable fluid resuscitation in case of AKI. This meta-analysis compares the effectiveness of different fluid resuscitation strategies in preventing AKI in critically ill patients. Methods: A systematic search was conducted in PubMed, MEDLINE, EMBASE, and Cochrane databases for randomized controlled trials comparing fluid resuscitation strategies in critically ill patients with AKI as an outcome. Random-effects meta-analysis was performed to calculate pooled odds ratios (OR) and risk ratios (RR) with 95% confidence intervals (CI). Results: There was no significant difference in AKI incidence between early goal-directed therapy (EGDT) vs usual care (OR 0.90, 95% CI 0.71-1.13) or crystalloids vs colloids (OR 1.03, 95% CI 0.89-1.18). Mortality rates were similar between EGDT vs usual care (RR 1.02, 95% CI 0.78-1.38) and crystalloids vs colloids (RR 1.03, 95% CI 0.93-1.14). The need for RRT did not differ significantly between strategies. Length of ICU stay was longer with EGDT vs usual care (MD 2.81 days, 95% CI 0.21-5.41) but similar between crystalloids and colloids. Conclusion: This meta-analysis found no significant differences in AKI incidence, mortality, or need for RRT between fluid resuscitation strategies in critically ill patients. EGDT was associated with longer ICU stays compared to usual care. Further research is needed to optimize fluid management in critical care settings.