A chloride-restrictive intravenous fluid strategy in the intensive care unit (ICU) is associated with significantly decreased incidence of acute kidney injury (AKI) and use of renal replacement therapy (RRT), according to a pilot study published in the Journal of the American Medical Association (2012;308:1566-1572).
Nor’azim Mohd Yunos, MD, of the Monash University Sunway Campus in Malaysia, and colleagues conducted a prospective, open-label, sequential period pilot study to assess the link between a chloride-restrictive intravenous fluid strategy and AKI in critically ill patients. During the control period, 760 patients admitted consecutively to the ICU were given standard intravenous fluids (chloride-liberal). These patients were compared with 773 patients admitted consecutively during the intervention period, one year later, who were given a lactated solution, a balanced solution (Plasma-Lyte 148), and chloride-poor 20% albumin.
The researchers found that the increase in mean serum creatinine level while in the ICU was 22.6 µmol/L during the control period versus 14.8 µmol/L for the intervention period, a difference that was statistically significant. The incidence of injury and failure class of RIFLE (risk, injury, failure, loss, end-stage)-defined AKI was 14% in the control group versus 8.4% in the intervention group, and the use of RRT was 10% versus 6.3%. These associations remained significant even after adjustment for other variables.
“The implementation of a chloride-restrictive strategy in a tertiary ICU was associated with a significant decrease in the incidence of AKI and use of RRT,” the authors wrote.