Volume overload is a common complication of a multitude of disease states, as well as a complication of many medical therapies. For the critically ill patient in the intensive care unit, volume overload is especially concerning when persistent past the first few days of admission. In the setting of chronic kidney disease, the maintenance of fluid balance presents additional challenges. This article focuses on the causes of volume overload as well as treatment options of the critically ill patient, including the nuances of the kidney patient, and ends with outpatient guidelines and recommendations to avoid recurrence.