Effect of 0.9% saline versus buffered crystalloid solution on renal complications in ICU patients. Based on concerns that renal artery blood flow (and hence nephron perfusion) falls to greater
Bellomo n 2012 demonstrated an association between chloride rich fluid and AKI
- Changed from gelatin, albumin and 0.9% saline to balanced
- Could be that gelatinS were harmful, rather than saline
Hence SPLIT
Double-blind, cluster randomised, double-crossover trial
4 ICUs in New Zealand April til October 2014
- 3 general medical and surgical
- 1 predominantly cardiothoracic and vascular surgery
Conducted in all centres with with each centre using 0.9% saline or Plasmalyte for blocks of 7 weeks x 2
2278 patients included
- 1152 Plasmlayte treated and analysed
- 1100 0.9% saline treated and analysed
99% of eligible patients were enrolled, followed up and analysed
Treatment groups had similar baseline characteristics
- About 60 years
- 2/3 male
- 42% cardiac surgery
- 60% elective surgical
- APACHE-II around 14
- Approx 60% had received buffered crystalloid pre-ICU and 30% saline
No difference in incidence of AKI (9.6% in Plasmalyte, 9.2% in 0.9% saline)
No difference in need for RRT
No difference in any of pre-defined subgroups (APACHE high or low, centre, sepsis, cardiac surgery)
No difference in mortality although not powered for that
Conclusion: Among patients receiving crystalloid fluid therapy in the ICU, use of a buffered crystalloid compared with saline did not reduce the risk of AKI.