Normal saline versus balanced crystalloids in patients with prerenal acute kidney injury and pre-existing chronic kidney disease

Author:

Papasotiriou Marios1,Mpratsiakou Adamantia1,Georgopoulou Georgia1,Ntrinias Theodoros1,Balta Lamprini1,Pavlakou Paraskevi1,Goumenos Dimitrios S.1,Papachristou Evangelos1

Affiliation:

1. 1 Department of Nephrology and Kidney Transplantation , University Hospital of Patras , Patras , Greece

Abstract

Abstract Introduction Normal saline (N/S) and Ringer’s-Lactate (L/R), are administered in everyday clinical practice. Despite that, N/S increases the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R has lower sodium content, significantly less chloride and contains lactates. In this study we compare the efficacy of L/R versus N/S administration in patients with prerenal acute kidney injury (AKI) and pre-established chronic kidney disease (CKD). Methods In this prospective open-label study we included patients with prerenal AKI and previously known CKD stage III-V without need for dialysis. Patients with other forms of AKI, hypervolemia or hyperkalemia were excluded. Patients received either N/S or L/R intravenously at a dose of 20 ml/kg body-weight/day. We studied kidney function at discharge and at 30 days, duration of hospitalization, acid-base balance and the need for dialysis. Results We studied 38 patients and 20 were treated with N/S. Kidney function improvement during hospitalization and at 30 days after discharge, was similar between the two groups. Duration of hospitalization was also similar. Anion-gap improvement as expressed with Δanion-gap between discharge and admission day was higher in those patients that received L/R in comparison to those that received N/S and pH increase (ΔpH) was slightly higher in the L/R group. No patient required dialysis. Conclusions Administration of L/R or N/S to patients with prerenal AKI and pre-established CKD had no significant difference in short or long term kidney function but L/R showed a better profile in acid-base balance improvement and Cl overload in comparison to N/S.

Publisher

Walter de Gruyter GmbH

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