Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial
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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.
KeywordsChloride Saline Acute kidney injury Perioperative Critical care Intensive care
D. McIlroy and J. Kasza had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The statistical analysis was jointly conducted by J. Kasza (biostatistician) and D. McIlroy. The study was jointly funded by grants from the Australian and New Zealand College of Anaesthetists and the Society of Cardiovascular Anesthesiologists/International Anesthesia Research Society. Neither of the funding bodies had any input into the design and conduct of the study, collection, management, analysis, and interpretation of data, nor preparation, review, or approval of the manuscript.
Compliance with ethical standards
Conflicts of interest
All of the authors declare that they have no potential conflicts of interest related to the submitted manuscript.
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