•AKI progresses in about 50% of septic patients despite hemodynamic optimization.
•We observed a weak association between systemic hemodynamic parameters and AKI in septic patients.
•Higher mean CVP in the first 24 hours was linearly associated with increasing risk of new or persistent AKI across all observed CVP values.
•The association of elevated CVP with AKI suggests a role of venous congestion in the development of AKI.
•The paradigm that targeting high CVP may reduce the occurrence of AKI should be revised.
These findings raise many questions. If we restrict volume to spare the kidneys do we under-resuscitate the rest of the body? What if we pour it on initially then cut back after 6 hours (early goal directed therapy)?