Table 4.
Retrospective studies comparing normal saline to balanced solutions across different clinical settings
| Study Description | Intravenous Fluid Comparison | Key Results | Comments | Association With AKI |
|---|---|---|---|---|
| Surgery | ||||
| Nationwide hospital database of patients undergoing either elective or emergency open abdominal surgery (197) | Normal saline (30,994 patients) vs. Plasma-Lyte (926 patients) | Normal saline associated with more postoperative infections, acute kidney infection (AKI) requiring renal replacement therapy (RRT), blood transfusions, and increased use of hospital resources compared with Plasma-Lyte | Patients who received normal saline were more likely to have undergone emergency rather than elective surgery, but rates of AKI remained significant even after adjustment | Yes |
| Organ transplantation | ||||
| Single-center study of 158 patients undergoing liver transplantation (136) | Normal saline vs. lactated Ringer’s | >3.2 liters of normal saline administration within the 1st postoperative day was associated with AKI | These patients may have been more hypotensive and at increased risk for AKI, as blood pressure was not included in the analysis | Yes |
| Sepsis | ||||
| Propensity matched cohort study using a multihospital electronic health record database of adults with systemic inflammatory response syndrome (SIRS) rather than overt sepsis (198) | Normal saline (1,558 patients) vs. balanced solution (1,558 patients) | Normal saline was not associated with greater rates in AKI | Normal saline was associated with greater in-hospital morbidity and more cardiac, infectious, and coagulopathy complications | No |
| Single-center cohort using a publicly available database of 8,085 intensive care unit (ICU) patients (253) | Normal saline vs. lactated Ringer’s | Lactated Ringer’s administration was associated with less AKI and reduced mortality during days 3 to 7 after ICU admission | The protective effect of lactated Ringer’s on AKI was more pronounced, as total fluid volume increased and was lost in subgroup analysis when <7 liters of fluid was infused | Yes |
| Propensity matched study of a nationwide cohort of septic ICU patients (170) | Normal saline (3,365 patients) vs. balanced solutions (3,365 patients) | No difference in AKI or need for RRT | Patients that received balanced solutions had a lower absolute mortality rate regardless of the total fluid volume received | No |
| Single-center cohort study of critically ill medical patients with severe sepsis or septic shock (72) | Normal saline (209 patients) vs. balanced solutions (201 patients) | Increased odds of AKI in the normal saline group | Both groups received large fluid volumes during the acute resuscitation period (median volume >6.5 liters) | Yes |
| Median ICU length of stay was 2 days longer in the normal saline group but no difference in in-hospital length of stay or all cause in-hospital mortality | ||||