Incidencia de lesión renal aguda en pacientes con Sepsis y Shock Séptico tratados con fluidoterapia: una revisión sistemática.

Introduction: Fluid resuscitation is fundamental in the management of septic patients. Among the solutions used, 0.9% saline (SS) remains controversial because it may increase the incidence of acute kidney injury (AKI) in adult patients with sepsis or septic shock compared to Ringer's Lactate (RL). Objective: Compare the use of SS with RL, to determine which fluid shows a lower incidence of AKI in patients with sepsis or septic shock in the emergency services (ES) and in the intensive care units (ICU). Methods: We did a systematic review of studies published in PubMed, Scopus and Web of Science in the last 5 years, using the PRISMA-P and PICO methods. We used the following MeSH terms: "sepsis", "fluid therapy", "crystalloids solutions", "acute kidney injury", "emergency service, hospital" and "intensive care units", excluding studies in animals, pediatrics population and pregnant women. Results: We included 4 studies (n = 18577). The first one showed a decrease in the incidence of AKI when using RL vs SS at 24 and 48 hours of admission in the ES (p<0,05). In the other studies, there was no significant difference found in AKI incidence in the patients admitted in the ICU (p-value = 0,39), (OR 0,91; 95% IC 0,82-1,01) and (OR 0,79; 95% IC 0,63-1,00), respectively. Conclusion: There is a slight evidence that shows that RL would be a better fluid for the treatment in this kind of patients. However, more studies are needed to assure this affirmation. [ABSTRACT FROM AUTHOR]