Clinical Assessment of Fluid Status in Adults With Acute Kidney Injury: A Scoping Review.
Karen Nagalingam, Lisa Whiting, Ken Farrington and 2 others
PMID 40186545WHAT IT FOUND
Nurses assessing fluid status in acute kidney injury should not rely on National Early Warning Scores, which failed to predict deterioration.
Instead, monitor hourly urine output, track daily weight changes of 1% or more, and check for sternal capillary refill over 4.5 seconds alongside signs of dehydration.
Key findings
01National Early Warning Scores are poor predictors of acute kidney injury and should not be used to determine deterioration severity in these patients.
02Intensive monitoring of urine output, specifically hourly recordings with no gaps greater than 3 hours, improves detection of acute kidney injury and reduces mortality.
03A weight increase of 1% or more is strongly associated with progression of acute kidney injury to Stage 2 or 3.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The included studies were all observational; no randomized trials were found, so causality cannot be established. Definitions of hypotension varied significantly between ward-based and critical care settings, limiting generalizability. Fluid balance data on general wards was often inaccurate due to missing entries, affecting the reliability of oliguria detection. The review excluded pediatric and pregnant populations, so findings apply only to non-pregnant adults.
Declared interests
No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that a normal National Early Warning Score rules out acute kidney injury. The review found that NEWS is a poor predictor for this specific condition, and patients with life-threatening electrolyte derangements or fluid imbalances can have normal scores.