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Abstract: SA-PO533

The Effect of Fluid Resuscitation with Normal Saline versus Ringer’s Acetate on Renal Function and Host Defense in Severe Sepsis/Septic Shock Patients: A Randomized Controlled Trial

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Kunupakan, Sasithorn, Chulalongkorn university, Bangkok, Thailand
  • Peerapornratana, Sadudee, Chulalongkorn University, Bangkok, Thailand
  • Lumlertgul, Nuttha, Renal Division, Chulalongkorn University, Bangkok, Thailand
  • Thamrongsat, Nicha, Chulalongkorn university, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
  • Tungsanga, Kriang, King Chulalong Memorial lHospital, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
  • Srisawat, Nattachai, Chulalongkorn university, Bangkok, Thailand
Background

Recent large observational studies in severe sepsis showed that Normal Saline (NSS) might worsen acute kidney injury (AKI) determined by serum creatinine. In animal model with sepsis, NSS could impair monocyte/neutrophil functions, the main host defense mechanism during sepsis, and this impairment might cause renal dysfunction.

Methods

NSS or RA was utilized for volume expansion during fluid resuscitation phase for 72 hours. The treatment followed the recommendations for fluid therapy provided by the Surviving Sepsis Campaign. Blood and urine samples were collected at 72 hrs. Primary outcome was median difference of uNGAL levels on day 3. Secondary outcomes were difference of monocyte HLA-DR (mHLA-DR)expression, neutrophil chemotaxis activity, and CD11b expression on day 3, and maximum AKI state on day 7.

Results

Fifty-nine patients were recruited, 29 and 30 for NSS and RA, respectively. The volume of resuscitation during the first 6 hours were comparable (NSS=1000 (1000,2000) mL, RA=1000 (700,1500) mL, p=0.38). Patients receiving NSS became more acidic than RA. There was no significant difference in renal function between both groups at baseline. The median uNGAL levels were not different between groups (NSS=111 (36.4, 262.2) ng/mL, RA= 32.7 (8.85, 178.1) ng/mL, p=0.59), mHLA-DR expression, neutrophil chemotaxis, and CD11b expression on day 3 were no improvement in NSS groups. But there were significant improvement in chemotaxis (p=0.024) and mHLA-DR expression (p=0.036) in RA group. The maximal AKI state determined by serum creatinine on day 7 were not different (NSS=24.1%, RA=26.7%, p=0.82).

Conclusion

Our study showed that there was significant improvement of immunoparalysis status (increased HLA-DR and chemotaxis activity) in RA group. No significant difference in tubular dysfunction between groups. (But lower trends of uNGAL and L-FABP in RA group.)

Funding

  • Government Support - Non-U.S.