IV fluid shortage raises AKI

Acute kidney injury is a sudden drop in kidney function, and new research found it became more common after hospitals cut back on IV fluids during a national shortage. (merckmanuals.com, sciencedirect.com) The shortage followed Hurricane Helene’s damage in late September 2024 to Baxter’s North Cove plant in North Carolina, which the CDC identified as the largest U.S. maker of intravenous and peritoneal dialysis solutions. Virginia health officials said Baxter accounted for about 60% of domestic IV solution production. (cdc.gov, vdh.virginia.gov) In the study, postoperative acute kidney injury rates rose from 10.4% before the shortage to 12.1% during the shortage, with a P value below 0.001. Anesthesiology News, citing the investigators, reported the same analysis also found less intraoperative crystalloid use and more colloid use during the shortage period. (anesthesiologynews.com, sciencedirect.com) Crystalloids are the standard salt-based fluids used in operating rooms to maintain blood pressure and organ perfusion during surgery. Merck says acute kidney injury often follows inadequate kidney perfusion from illness, trauma, or surgery, which is why fluid management is part of prevention and treatment. (bjanaesthesia.org.uk, merckmanuals.com) That made the 2024 shortage more than a supply-chain problem for hospitals. The British Journal of Anaesthesia reported that both very high and very low perioperative fluid volumes are linked to worse outcomes after noncardiac surgery, leaving operating room teams to conserve a product that is also part of routine risk control. (bjanaesthesia.org.uk, sciencedirect.com) Other health systems did not all report the same clinical effect. An American Journal of Health-System Pharmacy study of 68,430 encounters said a hospital-wide conservation program cut IV fluid use by 44% at peak without a significant change in acute kidney injury or mortality. (academic.oup.com, pmc.ncbi.nlm.nih.gov) Researchers have already been tracking other fallout from the shortage. A PLOS One study published in April 2026 said hospitals reported delayed procedures, conservation protocols, and operational strain after the Baxter shutdown. (journals.plos.org, ashp.org) The immediate question for hospitals is how to conserve fluids without pushing surgical patients into avoidable kidney stress. The longer-running question is whether a supply disruption at one North Carolina plant can keep changing bedside care across the country. (cdc.gov, baxter.com)