1. Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial
- Author
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Dhiraj Bhatia, Deirdre Murphy, Silvana Marasco, David R. McIlroy, Jessica Kasza, and Lisa Wutzlhofer
- Subjects
Adult ,Male ,medicine.medical_specialty ,Critical Care ,Sodium Chloride ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Perioperative Care ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,law ,Intensive care ,Anesthesiology ,medicine ,Humans ,Cardiac Surgical Procedures ,Infusions, Intravenous ,Aged ,Aged, 80 and over ,Creatinine ,business.industry ,Incidence ,Acute kidney injury ,030208 emergency & critical care medicine ,Odds ratio ,Perioperative ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Intensive care unit ,Surgery ,Cardiac surgery ,Intensive Care Units ,chemistry ,Anesthesia ,Fluid Therapy ,Administration, Intravenous ,Female ,business - Abstract
The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol. The perioperative protocol governed all fluid administration from commencement of anesthesia through to discharge from the intensive care unit and varied over four sequential periods, each lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a chloride-limited strategy, consisting of a buffered salt solution and 20% albumin, was used. Co-primary outcomes were peak delta serum creatinine (∆SCr) within 5 days after the operation and KDIGO-defined stage 2 or stage 3 acute kidney injury (AKI) within 5 days after the operation. We enrolled and analysed data from 1136 patients, with 569 patients assigned to a chloride-rich fluid strategy and 567 to a chloride-limited one. Compared with a chloride-limited strategy and adjusted for prespecified covariates, there was no association between a chloride-rich perioperative fluid strategy and either peak ∆S Cr, transformed to satisfy the assumptions of multivariable linear regression [regression coefficient 0.03, 95% confidence interval (CI) −0.03 to 0.08); p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI 0.65–1.47; p = 0.90]. A perioperative fluid strategy to restrict IV chloride administration was not associated with an altered incidence of AKI or other metrics of renal injury in adult patients undergoing cardiac surgery. Trial Registration: Clinicaltrials.gov Identifier: NCT02020538.
- Published
- 2017