{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T06:34:35Z","timestamp":1793860475344,"version":"4.6.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early fluid management in patients with advanced chronic kidney disease (CKD) and sepsis-induced hypotension is challenging with limited evidence to support treatment recommendations. We aimed to compare an early restrictive versus liberal fluid management for sepsis-induced hypotension in patients with advanced CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This\n                      <jats:italic>post-hoc<\/jats:italic>\n                      analysis included patients with advanced CKD (eGFR of less than 30\u00a0mL\/min\/1.73\u00a0m\n                      <jats:sup>2<\/jats:sup>\n                      or history of end-stage renal disease on chronic dialysis) from the crystalloid liberal or vasopressor early resuscitation in sepsis (CLOVERS) trial. The primary endpoint was death from any cause before discharge home by day 90.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1563 participants enrolled in the CLOVERS trial, 196 participants had advanced CKD (45% on chronic dialysis), with 92 participants randomly assigned to the restrictive treatment group and 104 assigned to the liberal fluid group. Death from any cause before discharge home by day 90 occurred significantly less often in the restrictive fluid group compared with the liberal fluid group (20 [21.7%] vs. 41 [39.4%], HR 0.5, 95% CI 0.29\u20130.85). Participants in the restrictive fluid group had more vasopressor-free days (19.7\u2009\u00b1\u200910.4\u00a0days vs. 15.4\u2009\u00b1\u200912.6\u00a0days; mean difference 4.3\u00a0days, 95% CI, 1.0\u20137.5) and ventilator-free days by day 28 (21.0\u2009\u00b1\u200911.8 vs. 16.5\u2009\u00b1\u200913.6\u00a0days; mean difference 4.5\u00a0days, 95% CI, 0.9\u20138.1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with advanced CKD and sepsis-induced hypotension, an early restrictive fluid strategy, prioritizing vasopressor use, was associated with a lower risk of death from any cause before discharge home by day 90 as compared with an early liberal fluid strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>NCT03434028 (2018-02-09), BioLINCC 14149.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-024-05019-6","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T06:02:29Z","timestamp":1720677749000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Fluid management for sepsis-induced hypotension in patients with advanced chronic kidney disease: a secondary analysis of the CLOVERS trial"],"prefix":"10.1186","volume":"28","clinical-trial-number":[{"clinical-trial-number":"nct03434028","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Anselm","family":"Jorda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivor S.","family":"Douglas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Staudinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gottfried","family":"Heinz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Bergmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Oberbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcrkan","family":"Seng\u00f6lge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Zeitlinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Jilma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan I.","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Gelbenegger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"issue":"5","key":"5019_CR1","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1056\/NEJMp1707170","volume":"377","author":"K Reinhart","year":"2017","unstructured":"Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority\u2014a WHO resolution. N Engl J Med. 2017;377(5):414\u20137.","journal-title":"N Engl J Med"},{"key":"5019_CR2","doi-asserted-by":"publisher","first-page":"16045","DOI":"10.1038\/nrdp.2016.45","volume":"2","author":"RS Hotchkiss","year":"2016","unstructured":"Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent JL. Sepsis and septic shock. Nat Rev Dis Primers. 2016;2:16045.","journal-title":"Nat Rev Dis Primers"},{"issue":"10219","key":"5019_CR3","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","volume":"395","author":"KE Rudd","year":"2020","unstructured":"Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the global burden of disease study. Lancet. 2020;395(10219):200\u201311.","journal-title":"Lancet"},{"issue":"5","key":"5019_CR4","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1111\/aas.13533","volume":"64","author":"RG Hahn","year":"2020","unstructured":"Hahn RG. Understanding volume kinetics. Acta Anaesthesiol Scand. 2020;64(5):570\u20138.","journal-title":"Acta Anaesthesiol Scand"},{"issue":"1","key":"5019_CR5","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13613-018-0402-x","volume":"8","author":"M Malbrain","year":"2018","unstructured":"Malbrain M, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D\u2019s and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66.","journal-title":"Ann Intensive Care"},{"issue":"1","key":"5019_CR6","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1097\/SHK.0000000000000268","volume":"43","author":"DJ Kelm","year":"2015","unstructured":"Kelm DJ, Perrin JT, Cartin-Ceba R, Gajic O, Schenck L, Kennedy CC. Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death. Shock. 2015;43(1):68\u201373.","journal-title":"Shock"},{"issue":"11","key":"5019_CR7","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","volume":"49","author":"L Evans","year":"2021","unstructured":"Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063\u2013143.","journal-title":"Crit Care Med"},{"key":"5019_CR8","doi-asserted-by":"publisher","first-page":"10539","DOI":"10.1038\/srep10539","volume":"5","author":"A Mansur","year":"2015","unstructured":"Mansur A, Mulwande E, Steinau M, Bergmann I, Popov AF, Ghadimi M, et al. Chronic kidney disease is associated with a higher 90-day mortality than other chronic medical conditions in patients with sepsis. Sci Rep. 2015;5:10539.","journal-title":"Sci Rep"},{"issue":"1","key":"5019_CR9","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1080\/07853890.2021.1987511","volume":"53","author":"R Bou Chebl","year":"2021","unstructured":"Bou Chebl R, Tamim H, Abou Dagher G, Sadat M, Ghamdi G, Itani A, et al. Sepsis in end-stage renal disease patients: are they at an increased risk of mortality? Ann Med. 2021;53(1):1737\u201343.","journal-title":"Ann Med"},{"issue":"Suppl 1","key":"5019_CR10","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.21037\/jtd.2019.12.84","volume":"12","author":"PE Marik","year":"2020","unstructured":"Marik PE, Byrne L, van Haren F. Fluid resuscitation in sepsis: the great 30\u00a0mL per kg hoax. J Thorac Dis. 2020;12(Suppl 1):S37\u201347.","journal-title":"J Thorac Dis"},{"issue":"11","key":"5019_CR11","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1097\/CCM.0000000000003960","volume":"47","author":"HI Kuttab","year":"2019","unstructured":"Kuttab HI, Lykins JD, Hughes MD, Wroblewski K, Keast EP, Kukoyi O, et al. Evaluation and predictors of fluid resuscitation in patients with severe sepsis and septic shock. Crit Care Med. 2019;47(11):1582\u201390.","journal-title":"Crit Care Med"},{"key":"5019_CR12","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.jcrc.2019.10.008","volume":"55","author":"K Rajdev","year":"2020","unstructured":"Rajdev K, Leifer L, Sandhu G, Mann B, Pervaiz S, Habib S, et al. Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: a case control study. J Crit Care. 2020;55:157\u201362.","journal-title":"J Crit Care"},{"key":"5019_CR13","doi-asserted-by":"crossref","unstructured":"National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network (2023) Early restrictive or liberal fluid management for sepsis-induced hypotension. N Engl J Med. 388(6): 499\u2013510","DOI":"10.1056\/NEJMoa2212663"},{"issue":"4","key":"5019_CR14","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.annemergmed.2018.03.039","volume":"72","author":"WH Self","year":"2018","unstructured":"Self WH, Semler MW, Bellomo R, Brown SM, deBoisblanc BP, Exline MC, et al. Liberal versus restrictive intravenous fluid therapy for early septic shock: rationale for a randomized trial. Ann Emerg Med. 2018;72(4):457\u201366.","journal-title":"Ann Emerg Med"},{"issue":"19","key":"5019_CR15","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1056\/NEJMsa1603542","volume":"376","author":"SA Coady","year":"2017","unstructured":"Coady SA, Mensah GA, Wagner EL, Goldfarb ME, Hitchcock DM, Giffen CA. Use of the national heart, lung, and blood institute data repository. N Engl J Med. 2017;376(19):1849\u201358.","journal-title":"N Engl J Med"},{"issue":"19","key":"5019_CR16","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","volume":"385","author":"LA Inker","year":"2021","unstructured":"Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New creatinine- and cystatin c-based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737\u201349.","journal-title":"N Engl J Med"},{"issue":"4","key":"5019_CR17","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","volume":"120","author":"A Khwaja","year":"2012","unstructured":"Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179\u201384.","journal-title":"Nephron Clin Pract"},{"issue":"22","key":"5019_CR18","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1001\/jama.2023.7560","volume":"329","author":"FG Zampieri","year":"2023","unstructured":"Zampieri FG, Bagshaw SM, Semler MW. Fluid therapy for critically ill adults with sepsis: a review. JAMA. 2023;329(22):1967\u201380.","journal-title":"JAMA"},{"issue":"2","key":"5019_CR19","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1097\/CCM.0000000000006135","volume":"52","author":"D De Backer","year":"2024","unstructured":"De Backer D, Deutschman CS, Hellman J, Myatra SN, Ostermann M, Prescott HC, et al. Surviving sepsis campaign research priorities 2023. Crit Care Med. 2024;52(2):268\u201396.","journal-title":"Crit Care Med"},{"issue":"6","key":"5019_CR20","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1038\/s41581-023-00683-3","volume":"19","author":"A Zarbock","year":"2023","unstructured":"Zarbock A, Nadim MK, Pickkers P, Gomez H, Bell S, Joannidis M, et al. Sepsis-associated acute kidney injury: consensus report of the 28th acute disease quality initiative workgroup. Nat Rev Nephrol. 2023;19(6):401\u201317.","journal-title":"Nat Rev Nephrol"},{"issue":"12","key":"5019_CR21","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1164\/rccm.202308-1448LE","volume":"208","author":"A Khader","year":"2023","unstructured":"Khader A, Zelnick LR, Sathe NA, Kestenbaum BR, Himmelfarb J, Johnson NJ, et al. The interaction of acute kidney injury with resuscitation strategy in sepsis: a secondary analysis of a multicenter, phase 3, randomized clinical trial (CLOVERS). Am J Respir Crit Care Med. 2023;208(12):1335\u20138.","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"5019_CR22","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/01.CCM.0000194535.82812.BA","volume":"34","author":"GS Martin","year":"2006","unstructured":"Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15\u201321.","journal-title":"Crit Care Med"},{"issue":"5","key":"5019_CR23","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1097\/CCM.0000000000003692","volume":"47","author":"DJ Pepper","year":"2019","unstructured":"Pepper DJ, Demirkale CY, Sun J, Rhee C, Fram D, Eichacker P, et al. Does obesity protect against death in sepsis? A retrospective cohort study of 55,038 adult patients. Crit Care Med. 2019;47(5):643\u201350.","journal-title":"Crit Care Med"},{"issue":"26","key":"5019_CR24","doi-asserted-by":"publisher","first-page":"2459","DOI":"10.1056\/NEJMoa2202707","volume":"386","author":"TS Meyhoff","year":"2022","unstructured":"Meyhoff TS, Hjortrup PB, Wetterslev J, Sivapalan P, Laake JH, Cronhjort M, et al. Restriction of intravenous fluid in ICU patients with septic shock. N Engl J Med. 2022;386(26):2459\u201370.","journal-title":"N Engl J Med"}],"container-title":["Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-024-05019-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13054-024-05019-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13054-024-05019-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T06:04:20Z","timestamp":1720677860000},"score":1,"resource":{"primary":{"URL":"https:\/\/ccforum.biomedcentral.com\/articles\/10.1186\/s13054-024-05019-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,11]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["5019"],"URL":"https:\/\/doi.org\/10.1186\/s13054-024-05019-6","relation":{},"ISSN":["1364-8535"],"issn-type":[{"value":"1364-8535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,11]]},"assertion":[{"value":"12 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A central institutional review board and NHLBI-appointed independent data and safety monitoring board reviewed and approved the trial protocol. The Ethics committee of the Medical University of Vienna waived the need for review for this <i>post-hoc<\/i> analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"No author reports conflict of interests relevant to this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"231"}}