[Three shades of fluids: Bergström 2.0 / Furosemide stress test / replacement fluid for therapeutic plasma exchange].

Fluids play an important role in clinical nephrology.1) Temperature of dialysate fluid has recently re-attracted a lot of attention. Individualized cooling of the dialysate (0.5 °C below predialysis ear temperature) has been shown to not only prevent intradialytic hypotension but also to improve myocardial contractility and to prevent white matter changes in CKD5D.2) Access fluid in AKI is associated with an increased mortality. While Furosemide has no place in treating AKI the Furosemide stress test can help to identify patients with AKI that will eventually need renal replacement therapy.3) Components of replacement fluid for therapeutic plasma exchange (albumin or fresh frozen plasma) are high in demand. Especially the cost for albumin increases year by year. Alternative solutions such as immunoadsorption should be studied and employed for those indications where replenishment of plasma components is not necessary. Further, a seperate reimbursement of repalcement fluid seems necessary to avoid a decline in treatment quality.