Balanced Crystalloids Reduce Kidney Events in ICU Patients

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For noncritically ill patients, no difference in number of hospital-free days for crystalloids versus saline
For noncritically ill patients, no difference in number of hospital-free days for crystalloids versus saline

(HealthDay News) -- Balanced crystalloids offer some benefits vs saline in critically ill and noncritically ill adults, according to 2 studies published online in the New England Journal of Medicine to coincide with the Society of Critical Care Medicine's Annual Critical Care Congress, held from Feb. 25 to 28 in San Antonio.

Matthew W. Semler, MD, from the Vanderbilt University Medical Center in Nashville, Tennessee, and colleague assigned 15,802 adults in 5 intensive care units (ICUs) to receive saline (7860 patients) or balanced crystalloids (7942 patients). The researchers found that 14.3% of patients in the balanced crystalloid group and 15.4% in the saline group had a major adverse kidney event (marginal odds ratio, 0.90; 95% confidence interval, 0.82 to 0.99; P=0.04).

Wesley H. Self, MD, MPH, from also from the Vanderbilt University Medical Center, and colleagues compared balanced crystalloids with saline among 13,347 adults treated with intravenous crystalloids in the emergency department who were hospitalized outside an ICU. There was no difference noted between the groups in the number of hospital-free days (median, 25 in each group; adjusted odds ratio with balanced crystalloids, 0.98; 95% confidence interval, 0.92 to 1.04; P=0.41). Compared with saline, balanced crystalloids resulted in a lower incidence of major adverse kidney events within 30 days (4.7 vs 5.6%; adjusted odds ratio, 0.82; 95% confidence interval, 0.70 to 0.95; P=0.01).

"Treatment with balanced crystalloids did not result in a shorter time to hospital discharge (hospital-free days) than treatment with saline," Self and colleagues write.

Several authors in the Self study disclosed financial ties to the pharmaceutical industry.

References

Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. New Engl J Med. doi:10.1056/NEJMoa1711584

Myburgh J. Patient-Centered Outcomes and Resuscitation Fluids. New Engl J Med. doi:10.1056/NEJMe1800449

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