Intravenous NaCl Administration in Patients with Severe Renal Impairment

Risk Assessment and Recommendations

Patients with eGFR <30 mL/min/1.73 m² are at significantly increased risk of fluid overload and further kidney damage when receiving IV fluids, according to the European Society of Cardiology 1
Severe renal impairment (eGFR 15 mL/min/1.73 m²) represents CKD stage 4, which is classified as "severely decreased" kidney function, as defined by the European Heart Journal 2
The American Journal of Kidney Diseases recommends considering consultation with nephrology before administering IV fluids to patients requiring volume expansion with eGFR of 15 mL/min/1.73 m² 3
The American Journal of Kidney Diseases also recommends monitoring for signs of fluid overload and considering more frequent monitoring of renal function in patients with eGFR of 15 mL/min/1.73 m² 3
Patients with eGFR of 15 mL/min/1.73 m² are approaching the threshold for dialysis, and diuretic use in this population must be carefully considered, as stated by the American Journal of Kidney Diseases and Diabetes/Metabolism Research and Reviews 3, 4
The Clinical and Molecular Hepatology notes that the presence of diabetes further increases the risk of adverse outcomes with IV fluid administration in patients with severe renal impairment 5
The American Journal of Kidney Diseases recommends monitoring electrolytes and renal function daily in patients with eGFR of 15 mL/min/1.73 m² receiving IV NaCl 3