Leonardo Marquez M.D. , Sara Medellin M.D. , Lu Wang M.S. , Kamal Maheshwari M.D. , Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. , Daniel I. Sessler M.D.
{"title":"术中生理盐水量与乳酸林格氏液量对急性肾损伤的影响:SOLAR试验的二次分析。","authors":"Leonardo Marquez M.D. , Sara Medellin M.D. , Lu Wang M.S. , Kamal Maheshwari M.D. , Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. , Daniel I. Sessler M.D.","doi":"10.1016/j.jclinane.2025.111744","DOIUrl":null,"url":null,"abstract":"<div><div>Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.</div></div><div><h3>Objective</h3><div>Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.</div></div><div><h3>Design</h3><div>Secondary analysis of a single-center multiple cross-over cluster trial.</div></div><div><h3>Setting</h3><div>Intraoperative care.</div></div><div><h3>Patients</h3><div>We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.</div></div><div><h3>Interventions</h3><div>Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.</div></div><div><h3>Main results</h3><div>The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or > 4 L of <em>lactated Ringer's</em> solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.</div></div><div><h3>Conclusions</h3><div>While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"101 ","pages":"Article 111744"},"PeriodicalIF":5.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial\",\"authors\":\"Leonardo Marquez M.D. , Sara Medellin M.D. , Lu Wang M.S. , Kamal Maheshwari M.D. , Andrew Shaw M.B., F.R.C.A., F.R.C.P.C., M.M.H.C. , Daniel I. Sessler M.D.\",\"doi\":\"10.1016/j.jclinane.2025.111744\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><div>Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.</div></div><div><h3>Objective</h3><div>Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.</div></div><div><h3>Design</h3><div>Secondary analysis of a single-center multiple cross-over cluster trial.</div></div><div><h3>Setting</h3><div>Intraoperative care.</div></div><div><h3>Patients</h3><div>We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.</div></div><div><h3>Interventions</h3><div>Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.</div></div><div><h3>Measurements</h3><div>The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.</div></div><div><h3>Main results</h3><div>The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or > 4 L of <em>lactated Ringer's</em> solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.</div></div><div><h3>Conclusions</h3><div>While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. 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Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial
Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI.
Objective
Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group.
Design
Secondary analysis of a single-center multiple cross-over cluster trial.
Setting
Intraoperative care.
Patients
We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution.
Interventions
Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution.
Measurements
The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0–1, 1–2, 3–4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h.
Main results
The risk of AKI did not differ significantly in patients given 0–1, 1–2, or 3–4 L saline or lactated Ringers solutions. In contrast, patients given 2–3 or > 4 L of lactated Ringer's solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories.
Conclusions
While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.