Preventive Intravenous Fluid Administration in Traumatic Rhabdomyolysis Patients at Risk of Acute Kidney Injury; a Systematic Review and Meta-analysis

To determine the optimum volume of intravenous fluid administration in traumatic rhabdomyolysis patients to prevent acute kidney injury (AKI) and the need for dialysis. Systematic search was done via the electronic databases Medline, Embase, Scopus, and Web of Science on January 21, 2024 using the query formed for keywords rhabdomyolysis, fluid therapy, and AKI. No filter was used. Citation searching was done, as well. Trials and observational studies reporting data on fluid therapy and AKI in traumatic rhabdomyolysis patients were included. Animal studies, case reports, reviews, and studies on non-traumatic causes were excluded. Risk of bias assessment was done using NHLBI tool for observational and cohort studies. The quality of evidence was assessed using the GRADE score. Analyses were carried out using STATA v.18 for outcomes AKI and dialysis by categorizing studies into three treatment volumes of ≤3 L/day, >3 L/day, and Better et al. protocols. Eight studies were included in the final analysis. The estimated prevalence of AKI and the need for dialysis in traumatic rhabdomyolysis patients were lowest when administering 3-8 L of IV fluid per 24 hours (AKI: 0.02 (95% CI: 0.00, 0.11) compared with 0.48 (95% CI: 0.0, 1.0), and 0.16 (95% CI: 0.01, 0.38) in studies administering ≤3 L/day, and those following Better et al. protocol, respectively; Dialysis: 0.01 (95% CI: 0.00, 0.03) compared with 0.05 (95% CI: 0.00, 0.18) in ≤3, and 0.16 (95% CI: 0.01, 0.38) in Better protocol.). All studies were of non-low risk of bias and the quality of evidence is very low. There is paucity of high quality data on fluid therapy in traumatic rhabdomyolysis, which warrants further studies. The scarce evidence is in favor of administering a volume of 3-8 L/day to prevent AKI and the need for dialysis in traumatic rhabdomyolysis patients, albeit with very low quality.