Effect of balanced crystalloids versus saline on urinary biomarkers of acute kidney injury in critically ill adults

Abstract Background Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury remains unknown. Methods From February 15 to July 15, 2016, we conducted an ancillary study to the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing the effect of balanced crystalloids versus saline on urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) among 261 consecutively-enrolled critically ill adults admitted from the emergency department to the medical ICU. After informed consent, we collected urine 36 ± 12 h after hospital admission and measured NGAL and KIM-1 levels using commercially available ELISAs. Levels of NGAL and KIM-1 at 36 ± 12 h were compared between patients assigned to balanced crystalloids versus saline using a Mann-Whitney U test. Results The 131 patients (50.2%) assigned to the balanced crystalloid group and the 130 patients (49.8%) assigned to the saline group were similar at baseline. Urinary NGAL levels were significantly lower in the balanced crystalloid group (median, 39.4 ng/mg [IQR 9.9 to 133.2]) compared with the saline group (median, 64.4 ng/mg [IQR 27.6 to 339.9]) (P < 0.001). Urinary KIM-1 levels did not significantly differ between the balanced crystalloid group (median, 2.7 ng/mg [IQR 1.5 to 4.9]) and the saline group (median, 2.4 ng/mg [IQR 1.3 to 5.0]) (P = 0.36). Conclusions In this ancillary analysis of a clinical trial comparing balanced crystalloids to saline among critically ill adults, balanced crystalloids were associated with lower urinary concentrations of NGAL and similar urinary concentrations of KIM-1, compared with saline. These results suggest only a modest reduction in early biomarkers of acute kidney injury with use of balanced crystalloids compared with saline. Trial registration ClinicalTrials.gov number: NCT02444988. Date registered: May 15, 2015.

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Effect of Balanced Crystalloids versus Saline on Urinary Biomarkers of Acute Kidney Injury in Critically Ill Adults

10.21203/rs.3.rs-44278/v1 ◽

2020 ◽

Author(s):

Blake Funke ◽

Karen Jackson ◽

Wesley Self ◽

Sean Collins ◽

Christina Saunders ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Kidney Injury ◽

Saline Group ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Kidney Injury Molecule 1 ◽

Critically Ill Adults ◽

Ill Adults ◽

Balanced Crystalloids ◽

Balanced Crystalloid

Abstract BACKGROUND Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury remains unknown.METHODS From February 15 to July 15, 2016, we conducted an ancillary study to the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing the effect of balanced crystalloids versus saline on urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) among 261 consecutively-enrolled critically ill adults admitted from the emergency department to the medical ICU. After informed consent, we collected urine 36 ± 12 hours after hospital admission and measured NGAL and KIM-1 levels using commercially available ELISAs. Levels of NGAL and KIM-1 at 36 ± 12 hours were compared between patients randomized to balanced crystalloids versus saline using a Mann-Whitney U test.RESULTS The 131 patients (50.2%) assigned to the balanced crystalloid group and the 130 patients (49.8%) assigned to the saline group were similar at baseline. Urinary NGAL levels were significantly lower in the balanced crystalloid group (median, 39.4 ng/mg [IQR 9.9 to 133.2]) compared with the saline group (median, 64.4 ng/mg [IQR 27.6 to 339.9]) (P < 0.001). Urinary KIM-1 levels did not significantly differ between the balanced crystalloid group (median, 2.7 ng/mg [IQR 1.5 to 4.9]) and the saline group (median, 2.4 ng/mg [IQR 1.3 to 5.0]) (P = 0.36).CONCLUSIONS In this ancillary analysis of a randomized trial comparing balanced crystalloids to saline among critically ill adults, balanced crystalloids were associated with lower urinary concentrations of NGAL and similar urinary concentrations of KIM-1, compared with saline. These results suggest only a modest reduction in early biomarkers of acute kidney injury with use of balanced crystalloids compared with saline.TRIAL REGISTRATION: ClinicalTrials.gov numbers, NCT02444988 and NCT02547779

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Balanced Crystalloids versus Saline in Critically Ill Adults with Hyperkalemia or Acute Kidney Injury: Secondary Analysis of a Clinical Trial

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/rccm.202011-4122le ◽

2021 ◽

Author(s):

Alexandra H. Toporek ◽

Matthew W Semler ◽

Wesley H Self ◽

Gordon R. Bernard ◽

Li Wang ◽

...

Keyword(s):

Clinical Trial ◽

Acute Kidney Injury ◽

Critically Ill ◽

Secondary Analysis ◽

Kidney Injury ◽

Critically Ill Adults ◽

Ill Adults ◽

Balanced Crystalloids

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Distinct injury markers for the early detection and prognosis of incident acute kidney injury in critically ill adults with preserved kidney function

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563213503611a ◽

2013 ◽

Vol 50 (6) ◽

pp. 625-626

Author(s):

Sadie Redding

Keyword(s):

Acute Kidney Injury ◽

Early Detection ◽

Critically Ill ◽

Kidney Function ◽

Kidney Injury ◽

Critically Ill Adults ◽

Ill Adults

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Balanced Crystalloids Versus Saline in Critically Ill Adults: A Systematic Review and Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/1060028019866420 ◽

2019 ◽

Vol 54 (1) ◽

pp. 5-13 ◽

Cited By ~ 6

Author(s):

Drayton A. Hammond ◽

Simon W. Lam ◽

Megan A. Rech ◽

Melanie N. Smith ◽

Jennifer Westrick ◽

...

Keyword(s):

Critically Ill ◽

Observational Studies ◽

Randomized Trials ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Central Register ◽

Central Register ◽

Critically Ill Adults ◽

Ill Adults ◽

Balanced Crystalloids

Background: The optimal resuscitative fluid remains controversial. Objective: To assess the association between crystalloid fluid and outcomes in critically ill adults. Methods: Cumulative Index to Nursing and Allied Health Literature, Scopus, PubMed, and Cochrane Central Register for Controlled Trials were searched from inception through July 2019. Cohort studies and randomized trials of critically ill adults provided predominantly nonperioperative fluid resuscitation with balanced crystalloids or 0.9% sodium chloride (saline) were included. Results: Thirteen studies (n = 30 950) were included. Balanced crystalloids demonstrated lower hospital or 28-/30-day mortality (risk ratio [RR] = 0.86; 95% CI = 0.75-0.99; I2 = 82%) overall, in observational studies (RR = 0.64; 95% CI = 0.41-0.99; I2 = 63%), and approached significance in randomized trials (RR = 0.94; 95% CI = 0.88-1.02; I2 = 0%). New acute kidney injury occurred less frequently with balanced crystalloids (RR = 0.91; 95% CI = 0.85-0.98; I2 = 0%), though progression to renal replacement therapy was similar (RR = 0.91; 95% CI = 0.79-1.04; I2 = 38%). In the sepsis cohort, odds of hospital or 28-/30-day mortality were similar, but the odds of major adverse kidney events occurring in the first 30 days were less with balanced crystalloids than saline (OR = 0.78; 95% CI = 0.66-0.91; I2 = 42%). Conclusion and Relevance: Resuscitation with balanced crystalloids demonstrated lower hospital or 28-/30-day mortality compared with saline in critically ill adults but not specifically those with sepsis. Balanced crystalloids should be provided preferentially to saline in most critically ill adult patients.

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