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Abstract: SA-PO534

Balanced Crystalloids vs Normal Saline and Risk of AKI in Critically Ill Patients: A Systematic Review and Meta-Analysis

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Tang, Mengyao, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Cherian, Jerald, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Kalim, Sahir, Massachusetts General Hospital/ Harvard Medical School, Cambridge, Massachusetts, United States

In both animals and in vitro human studies, the high chloride content of normal saline (NS) has been linked with adverse pathophysiological effects. Emerging evidence, including a recent large clinical trial, suggests that balanced fluids (e.g. lactated Ringer or Plasma-Lyte A) may result in fewer adverse renal outcomes. However, whether NS is associated with a higher incidence of AKI when compared to balanced crystalloids in critically ill adults remains controversial.


A meta-analysis of RCTs and observational studies that enrolled critically ill patients receiving balanced crystalloids or NS in an ICU setting was conducted. Electronic databases (PubMed, EMBASE, Cochrane) were searched from inception until April 2018. Relative risks (RR) and 95% CIs were pooled using the random effects model in STATA. The primary outcome was AKI, as defined by the individual study. The secondary outcome was the requirement for renal replacement therapy (RRT).


Five studies with a total of 24,429 patients met the eligibility criteria and were included. The definition of AKI was based on KIDGO criteria, RIFLE criteria or ICD-9 code. The risk of AKI with balanced crystalloids was not significantly different when compared to NS (RR 0.94; 95% CI, 0.87, 1.01, p=0.08) (Figure 1), but there was a trend toward a more favorable outcome. There was also no difference between the two groups in new RRT requirements (RR 0.98; 95% CI, 0.87, 1.09, p=0.65).


Although there is a trend toward less detriment to renal function with balanced crystalloids, the current evidence insufficiently supports their use over NS for fluid resuscitation to decrease the risk of AKI or RRT requirement in critically ill patients in the ICUs. Current studies are limited by the inconsistent definition of AKI. Therefore, additional clinical trials adopting a standardized AKI definition are needed to further clarify the ideal resuscitation fluid for critically ill patients.