Abstract: FR-PO074
The Effect of 0.9% NaCl Compared with Plasma-Lyte on Biomarkers of Kidney Damage in Patients Undergoing Primary Uncemented Hip Replacement
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Oestergaard, Ann Mai, Regional Hospital Holstebro and Aarhus University, Denmark, Holstebro, Denmark
- Mose, Frank H., Regional Hospital Holstebro and Aarhus University, Denmark, Holstebro, Denmark
- Bech, Jesper N., Regional Hospital Holstebro and Aarhus University, Denmark, Holstebro, Denmark
Background
Isotonic saline (0.9% NaCl) induces hyperchloremic acidosis and is suspected to increase risk of acute kidney injury (AKI) and the need for renal-replacement-therapy in critically ill patients. Novel biomarkers such as neutrophil gelatinase associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) may have potential as early indicators of AKI.
Methods
In a double-blinded, placebo-controlled study, 38 patients undergoing primary uncemented hip replacement surgery were randomized to 0,9% NaCl or Plasma-Lyte (PL). Infusion was given during surgery as 15 ml/kg the first hour and 5 ml/kg the following two hours.
Urinary spot samples were collected upon admission and the day after surgery. As surgery initiated, urine was collected over the course of 4 hours. Hereafter another urine collection proceeded until the following morning. Urine was analyzed for concentrations of NGAL, KIM-1, Cl, Na, and albumin. Arterial and venous blood samples for measurements of pH and plasma electrolytes were collected as surgery was initiated, at the end of surgery and the following morning.
Results
NaCl induced an increase in P-Cl (111±2 mmol/L after NaCl and 108±3 after PL, p = 0.004) and a drop in pH (7.39±0.02 after NaCl and 7.43±0.03 after PL, p = 0.001).
Urinary excretion of NGAL increased significantly in both groups (ΔNGAL: 5.5 [4.1;11.7] µg/mmol creatinine p=0.004 after NaCl vs. 5.5 [2.1;9.4] µg/mmol creatinine after PL, p<0.001). There was no difference in the increase between groups (p=0.839)
Similarly, urinary excretion of KIM-1 also increased significantly in both groups (ΔKIM-1: NaCl 115.8 [74.1;156.2] ng/mmol creatinine, p<0.001 vs. PL 152.4 [120.1;307.9] ng/mmol creatinine, p<0.001). There was no difference in the increase between groups (p=0.064)
eGFR decreased after surgery for both groups (116±26 ml/min after NaCl vs. 111±21 after PL, p =0.470), but no difference in response was found between groups (p=0.891).
Conclusion
A hyperchloremic acidosis was present in the group receiving isotonic saline.
No difference was found between the groups in the excretion of u-NGAL and u-KIM-1 and responses to fluid infusion. However, both NGAL and KIM-1 were dramatically increased in both groups after surgery, despite no changes in eGFR. These results may indicate that surgery induced subclinical kidney damage.
Funding
- Private Foundation Support