Evidence map›Paper›PMID 42218546›Full record

ArticleCritical care (London, England)2026

Effect of restrictive fluid balance in critically ill patients with acute kidney injury: a target trial emulation.

Kyle Christopher White, Ary Serpa Neto, Kevin B Laupland, Michelle Gatton, Mahesh Ramanan, Anis Chaba, Stephen Whebell, Alexis Tabah, Kiran Shekar, James McCullough and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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.

Kyle Christopher WhiteIntensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia. kyle.white@health.qld.gov.au.
Ary Serpa NetoDepartment of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.
Kevin B LauplandSchool of Medicine, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
Michelle GattonSchool of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
Mahesh RamananSchool of Medicine, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
Anis ChabaDepartment of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia.
Stephen WhebellIntensive Care Unit, Townsville University Hospital, Townsville, QLD, Australia.
Alexis TabahSchool of Medicine, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
Kiran ShekarFaculty of Medicine, Mayne Academy of Critical Care, University of Queensland, St Lucia, QLD, Australia.
James McCulloughIntensive Care Unit, Gold Coast University Hospital, Southport, QLD, Australia.
Aashish KumarIntensive Care Unit, Logan Hospital, Logan, QLD, Australia.
Peter GarrettSchool of Medicine and Dentistry, Griffith University, Mount Gravatt, Brisbane, QLD, Australia.
Antony AttokaranFaculty of Medicine, Mayne Academy of Critical Care, University of Queensland, St Lucia, QLD, Australia.
Stephen LukeIntensive Care Services, Mackay Base Hospital, Mackay, QLD, Australia.
Sebastiaan BlankIntensive Care Unit, Townsville University Hospital, Townsville, QLD, Australia.
Queensland Critical Care Research Network (QCCRN)#

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo estimate the effect of restrictive fluid management on renal function and mortality in critically ill patients with acute kidney injury (AKI) at high risk of developing positive fluid balance.

methodsWe conducted a target trial emulation using data from 12 intensive care units in Queensland, Australia (2015-2021). Adults with AKI within 72 h of intensive care unit (ICU) admission and an AKI-Fluid Balance Risk Score ≥ 32 were included. The intervention comprised conservative crystalloid administration, restricted nutritional fluid intake, and diuretic use for 72 h. We estimated per-protocol effects using a sequential doubly robust estimator for longitudinal modified treatment policies. The primary outcome was AKI Rank at day 7; secondary outcomes included 30-day mortality.

resultsAmong 8,685 patients, the intervention was associated with substantial reduction in fluid balance (- 2,304 mL at 72 h; 95% CI, - 2,465 to - 2,144) and modest improvement in AKI Rank (mean difference - 0.8; 95% confidence interval (CI), - 1.3 to - 0.3). Heterogeneity by AKI stage was observed: the intervention was associated with improved renal function in stage 1 AKI (mean difference - 3.1; 95% CI, - 3.8 to - 2.5) but worse outcomes in stage 2 AKI (mean difference 4.5; 95% CI, 3.8 to 5.1) and stage 3 AKI (mean difference 6.3; 95% CI, 4.7 to 7.9) with increased 30-day mortality (relative risk 1.20; 95% CI, 1.09 to 1.33). Effective sample sizes were limited (7-16%), indicating reliance on extrapolation.

conclusionsRestrictive fluid management was associated with improved renal function in early AKI but potentially harmful effects in stages 2 and 3 AKI. These hypothesis-generating findings suggest any future trial should incorporate safety criteria for patients with advanced renal injury.

Indexed as

Acute Kidney InjuryFluid TherapyWater-Electrolyte BalanceAgedCritical IllnessFemaleHumansIntensive Care UnitsMaleMiddle AgedQueenslandAcute kidney injuryCritical illnessFluid balanceFluid therapyTarget trial emulation

Identifiers

PMID42218546
PMCPMC13439791

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LicenceCC BY-NC-ND
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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.