Evidence map›Paper›PMID 33961058›Full record

Trial reportIntensive care medicine2021

Restrictive fluid management versus usual care in acute kidney injury (REVERSE-AKI): a pilot randomized controlled feasibility trial.

Suvi T Vaara, Marlies Ostermann, Laurent Bitker, Antoine Schneider, Elettra Poli, Eric Hoste, Jan Fierens, Michael Joannidis, Alexander Zarbock, Frank van Haren and 6 more

Open access · hybridAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Intensive care medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 6 pooled it
16.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 6 syntheses or guidelines pooled it, 94 citations in OpenAlex.

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  5. Diuretics for preventing and treating acute kidney injury.The Cochrane database of systematic reviews · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 13 institutions in 8 countries.

Suvi T VaaraDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. suvi.vaara@helsinki.fi.ORCID 0000-0002-6851-3828
Marlies OstermannDepartment of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK.
Laurent BitkerDepartment of Intensive Care, Austin Hospital, Melbourne, Australia.
Antoine SchneiderAdult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Elettra PoliAdult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Eric HosteIntensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium.
Jan FierensIntensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium.
Michael JoannidisDivision of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Alexander ZarbockDepartment of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.
Frank van HarenAustralian National University Medical School, Canberra, Australia.
John ProwleCritical Care and Preoperative Medicine Research Group, Centre for Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, UK.
Tuomas SelanderScience Service Center, Kuopio University Hospital, Kuopio, Finland.
Minna BäcklundDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Ville PettiläDivision of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Rinaldo BellomoDepartment of Intensive Care, Austin Hospital, Melbourne, Australia.
REVERSE-AKI study team
University of Helsinki · FIGhent University Hospital · BEUniversity Hospital of Lausanne · CHQueen Mary University of London · GBSt Thomas' Hospital · GBThe University of Melbourne · AUUniversité Claude Bernard Lyon 1 · FRAustralian National University · AUUniversity Hospital Münster · DECanberra Hospital · AUHerttoniemi Hospital · FIInnsbruck Medical University · ATKuopio University Hospital · FI

Funding

Terveyden Tutkimuksen Toimikunta 317061Valtion tutkimusrahoitus TYH2017241
6 · The paper itself

Abstract

purposeWe compared a restrictive fluid management strategy to usual care among critically ill patients with acute kidney injury (AKI) who had received initial fluid resuscitation.

methodsThis multicenter feasibility trial randomized 100 AKI patients 1:1 in seven ICUs in Europe and Australia. Restrictive fluid management included targeting negative or neutral daily fluid balance by minimizing fluid input and/or enhancing urine output with diuretics administered at the discretion of the clinician. Fluid boluses were administered as clinically indicated. The primary endpoint was cumulative fluid balance 72 h from randomization.

resultsMean (SD) cumulative fluid balance at 72 h from randomization was - 1080 mL (2003 mL) in the restrictive fluid management arm and 61 mL (3131 mL) in the usual care arm, mean difference (95% CI) - 1148 mL (- 2200 to - 96) mL, P = 0.033. Median [IQR] duration of AKI was 2 [1-3] and 3 [2-7] days, respectively (median difference - 1.0 [- 3.0 to 0.0], P = 0.071). Altogether, 6 out of 46 (13%) patients in the restrictive fluid management arm and 15 out of 50 (30%) in the usual care arm received renal replacement therapy (RR 0.42; 95% CI 0.16-0.91), P = 0.043. Cumulative fluid balance at 24 h and 7 days was lower in the restrictive fluid management arm. The dose of diuretics was not different between the groups. Adverse events occurred more frequently in the usual care arm.

conclusionsIn critically ill patients with AKI, a restrictive fluid management regimen resulted in lower cumulative fluid balance and less adverse events compared to usual care. Larger trials of this intervention are justified.

Indexed as

Acute Kidney InjuryFluid TherapyAustraliaCritical IllnessEuropeFeasibility StudiesHumansPilot ProjectsAcute kidney injuryCritically illFluid balanceRestrictive fluid management

Identifiers

PMID33961058
PMCPMC8195764
OpenAlexW3157685261

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.