Aggressive vs non-aggressive fluid resuscitation for the prevention of acute kidney injury in acute pancreatitis: a meta-analysis

Acute kidney injury (AKI) is a common complication of acute pancreatitis (AP) and is associated with a poor prognosis. The role of early aggressive fluid resuscitation (AFR) in reducing AKI incidence in AP remains controversial. This systematic review and meta-analysis aimed to investigate the association between fluid resuscitation and AKI in AP patients. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number: CRD42024557258). To evaluate the association between early AFR and the incidence of AKI in patients with acute pancreatitis. A comprehensive search of Web of Science, PubMed, Cochrane Library, EMBASE, and Springer was conducted using the terms “acute pancreatitis”, “acute kidney injury” or “AKI” or “acute kidney damage”, and “fluid resuscitation” or “fluid hydration” for studies published between January 1, 2000, and January 1, 2026. Two independent investigators extracted patient data and study characteristics. Disagreements were resolved through consensus. The Cochrane systematic evaluation tool and Newcastle–Ottawa Scale were used to assess the quality of evidence for prospective and retrospective studies, respectively. A random-effect meta-analytical model was used for data synthesis. The dose–response analysis explored the correlation between the volume of fluid resuscitation (L/day) and the relative risk (RR) of AKI. Subgroup analysis and meta-regression investigated the heterogeneity. Five randomized controlled trials (RCTs) and six retrospective studies with a total of 10,060 cases were included in this meta-analysis. The meta-analysis indicated that compared to non-aggressive fluid resuscitation (NAFR), AFR was associated with a significantly higher incidence of AKI in acute pancreatitis patients (RR: 1.57; 95% CI 1.15–2.16) under the random-effect model. Dose–response analysis showed that the rate of increase in risk of AKI increased with increasing fluid resuscitation volume using fixed-volume thresholds, particularly when exceeding 3 L per day. However, using a precise, weight-based fluid resuscitation approach potentially decreases AKI risk in AP patients. In acute pancreatitis, uncontrolled and excessive AFR may be associated with the risk of AKI. This information is crucial for dosing decisions in clinical practice.