Table 5.
Crystalloid and colloid solutions in prevention of AKI.
| Study | Objective | Definition | Intervention | Results | Conclusion |
|---|---|---|---|---|---|
| Myburgh et al[40]. | To investigate the efficacy of hydroxyethyl starch (HES) for fluid resuscitation and effects on renal function. | RIFLE | 6% HES in 0.9% saline vs. 0.9% saline solutions until discharge, death, or 90-day randomisation. | AKI incidence: 34.6% in HES group vs. 38% in saline group. Renal replacement therapy (RRT) incidence: 7.0% in HES group vs. 5.8% in saline group. | HES provided no clinical benefit and resulted in increased rate of RRT. |
| Haase et al.[68] | To evaluate the efficacy of prophylactic bicarbonate-based infusion to reduce the incidence of AKI in patients undergoing open heart surgery. | RIFLE | Sodium bicarbonate (5.1 mmol/mL) vs. saline solution started before surgery until 24 hours after the end of procedure. | AKI incidence: 47.7% in sodium bicarbonate group vs. 36.4% in control group.Mortality in bicarbonate group was 6.3% vs. 1.7% in control group | Greater mortality and no prophylactic effect associated with sodium bicarbonate solution. |
| Soh et al.[41] | To investigate the preoperative administration of sodium bicarbonate in postoperative AKI prevention after off-pump coronary revascularization. | AKIN | Sodium bicarbonate (0.5 mmol kg-1 for 1 h upon induction of anaesthesia followed by 0.15 mmol kg-1 h-1 for 23 h) vs. 0.9% saline. | Incidence of AKI: 21% in bicarbonate group vs. 26% in control group. More patients required prolonged mechanical ventilation (> 24 h) relative to the control group. | Perioperative use of sodium bicarbonate did not reduce incidence of AKI and might be associated with a needed for prolonged ventilatory care. |
| Young et al[38]. | To investigate the effect of buffered crystalloid compared with saline on renal complications in patients in the ICU. | RIFLE | Double-blind cluster randomised double-crossover trial in 4 ICUs. Participants were assigned Plasma-Lyte 148 or saline solution for alternating treatment blocks of 7 weeks over 28 weeks. | 9.6% developed AKI within 90 days in buffered crystalloid group vs. to 9.2% in saline group. | Use of crystalloid fluid therapy was ineffective in prevention of AKI in the ICU. |
AKI=acute kidney injury; AKIN=Acute Kidney Injury Network; ICU=intensive care unit; RIFLE=Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease