This article is more than 5 years old. Information may no longer be current.
Study highlights effects of balanced crystalloids vs saline in critically ill adults
Click Here to Manage Email Alerts
Compared with use of saline, the use of balanced crystalloids for intravenous fluid administration was associated with a lower rate of the composite outcome of death from any cause, new renal-replacement therapy or persistent renal dysfunction among critically ill adults, according to findings published in the New England Journal of Medicine.
“The take-home of the article is that routine use of balanced crystalloids, instead of saline, resulted in fewer patients dying, needing to start dialysis or leaving the hospital with persistent renal dysfunction,” Todd W. Rice, MD, associate professor of medicine in the division of allergy, pulmonary, and critical care medicine at Vanderbilt University Medical Center and co-author of the study, told Healio Nephrology.
In the pragmatic, cluster-randomized, multiple-crossover trail conducted in five ICUs at an academic center, 15,802 adults received saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) between June 1, 2015 and April 30, 2017.
The primary outcome of the trial showed 1,139 patients in the balanced-crystalloids group and 1,211 patients in the saline group had a major adverse kidney event. Secondary outcomes showed 818 patients in the balanced-crystalloids group died before being discharged and within 30 days of ICU admission compared with 875 patients in the saline group, and 189 patients in the balanced-crystalloids group and 220 patients in the saline group received new renal-replacement therapy.
It was noted that use of balanced crystalloids over saline resulted in an absolute difference of 1.1 percentage points in favor of the balanced crystalloids in the primary outcome. The trial also concluded that in-hospital mortality at 30 days was 10.3% in the balanced-crystalloid group and was 11.1% in the saline group; incidence of new renal-replacement therapy was 2.5% and 2.9% respectively; and the incidence of persistent renal dysfunction was 6.4% and 6.6 %, respectively.
“Overall, the difference was small, but significant, and given that millions of patients each year receive isotonic crystalloids during their hospitalization, the overall effect on patient lives and kidney function in the population at large is significant,” Rice added. – by Jake Scott
Disclosure: The study was funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrails.gov numbers, NCT02444988 and NCT02547779.
Click Here to Manage Email Alerts