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

Marios Papasotiriou; Adamantia Mpratsiakou; Georgia Georgopoulou; Theodoros Ntrinias; Lamprini Balta; Paraskevi Pavlakou; Dimitrios S. Goumenos; Evangelos Papachristou

doi:10.2478/rjim-2023-0007

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

Romanian Journal of Internal Medicine

Volume 61 (2023): Issue 2 (June 2023)

By: Marios Papasotiriou, Adamantia Mpratsiakou, Georgia Georgopoulou, Theodoros Ntrinias, Lamprini Balta, Paraskevi Pavlakou, Dimitrios S. Goumenos and Evangelos Papachristou

Open Access

|May 2023

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.

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Articles in this issue

DOI: https://doi.org/10.2478/rjim-2023-0007 | Journal eISSN: 2501-062X | Journal ISSN: 1220-4749

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Language: English

Page range: 98 - 105

Submitted on: Sep 25, 2022

Published on: May 8, 2023

Published by: N.G. Lupu Internal Medicine Foundation

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

acute kidney injury,

balanced solutions,

chronic kidney disease,

Related subjects:

Internal medicine, other,

Cardiology,

Gastroenterology,

Rheumatology

© 2023 Marios Papasotiriou, Adamantia Mpratsiakou, Georgia Georgopoulou, Theodoros Ntrinias, Lamprini Balta, Paraskevi Pavlakou, Dimitrios S. Goumenos, Evangelos Papachristou, published by N.G. Lupu Internal Medicine Foundation
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Volume 61 (2023): Issue 2 (June 2023)