Effect of balanced crystalloids versus saline on urinary biomarkers of acute kidney injury in critically ill adults.
Critical care
Dialysis
Renal insufficiency
Resuscitation
Sepsis
Sodium chloride
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
05 02 2021
05 02 2021
Historique:
received:
04
09
2020
accepted:
07
01
2021
entrez:
6
2
2021
pubmed:
7
2
2021
medline:
15
12
2021
Statut:
epublish
Résumé
Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury remains unknown. From February 15 to July 15, 2016, we conducted an ancillary study to the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing the effect of balanced crystalloids versus saline on urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) among 261 consecutively-enrolled critically ill adults admitted from the emergency department to the medical ICU. After informed consent, we collected urine 36 ± 12 h after hospital admission and measured NGAL and KIM-1 levels using commercially available ELISAs. Levels of NGAL and KIM-1 at 36 ± 12 h were compared between patients assigned to balanced crystalloids versus saline using a Mann-Whitney U test. The 131 patients (50.2%) assigned to the balanced crystalloid group and the 130 patients (49.8%) assigned to the saline group were similar at baseline. Urinary NGAL levels were significantly lower in the balanced crystalloid group (median, 39.4 ng/mg [IQR 9.9 to 133.2]) compared with the saline group (median, 64.4 ng/mg [IQR 27.6 to 339.9]) (P < 0.001). Urinary KIM-1 levels did not significantly differ between the balanced crystalloid group (median, 2.7 ng/mg [IQR 1.5 to 4.9]) and the saline group (median, 2.4 ng/mg [IQR 1.3 to 5.0]) (P = 0.36). In this ancillary analysis of a clinical trial comparing balanced crystalloids to saline among critically ill adults, balanced crystalloids were associated with lower urinary concentrations of NGAL and similar urinary concentrations of KIM-1, compared with saline. These results suggest only a modest reduction in early biomarkers of acute kidney injury with use of balanced crystalloids compared with saline. ClinicalTrials.gov number: NCT02444988 . Date registered: May 15, 2015.
Sections du résumé
BACKGROUND
Recent trials have suggested use of balanced crystalloids may decrease the incidence of major adverse kidney events compared to saline in critically ill adults. The effect of crystalloid composition on biomarkers of early acute kidney injury remains unknown.
METHODS
From February 15 to July 15, 2016, we conducted an ancillary study to the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) comparing the effect of balanced crystalloids versus saline on urinary levels of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) among 261 consecutively-enrolled critically ill adults admitted from the emergency department to the medical ICU. After informed consent, we collected urine 36 ± 12 h after hospital admission and measured NGAL and KIM-1 levels using commercially available ELISAs. Levels of NGAL and KIM-1 at 36 ± 12 h were compared between patients assigned to balanced crystalloids versus saline using a Mann-Whitney U test.
RESULTS
The 131 patients (50.2%) assigned to the balanced crystalloid group and the 130 patients (49.8%) assigned to the saline group were similar at baseline. Urinary NGAL levels were significantly lower in the balanced crystalloid group (median, 39.4 ng/mg [IQR 9.9 to 133.2]) compared with the saline group (median, 64.4 ng/mg [IQR 27.6 to 339.9]) (P < 0.001). Urinary KIM-1 levels did not significantly differ between the balanced crystalloid group (median, 2.7 ng/mg [IQR 1.5 to 4.9]) and the saline group (median, 2.4 ng/mg [IQR 1.3 to 5.0]) (P = 0.36).
CONCLUSIONS
In this ancillary analysis of a clinical trial comparing balanced crystalloids to saline among critically ill adults, balanced crystalloids were associated with lower urinary concentrations of NGAL and similar urinary concentrations of KIM-1, compared with saline. These results suggest only a modest reduction in early biomarkers of acute kidney injury with use of balanced crystalloids compared with saline.
TRIAL REGISTRATION
ClinicalTrials.gov number: NCT02444988 . Date registered: May 15, 2015.
Identifiants
pubmed: 33546622
doi: 10.1186/s12882-021-02236-x
pii: 10.1186/s12882-021-02236-x
pmc: PMC7863046
doi:
Substances chimiques
Biomarkers
0
Crystalloid Solutions
0
Isotonic Solutions
0
Banques de données
ClinicalTrials.gov
['NCT02444988']
Types de publication
Comparative Study
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
54Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000445
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL143053
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002243
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL123033
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL153584
Pays : United States
Investigateurs
Gordon R Bernard
(GR)
Ryan M Brown
(RM)
Jonathan D Casey
(JD)
Todd W Rice
(TW)
Matthew W Semler
(MW)
Christopher J Lindsell
(CJ)
Li Wang
(L)
Jonathan P Wanderer
(JP)
Wesley H Self
(WH)
Edward D Siew
(ED)
Joanna L Stollings
(JL)
Références
Am J Respir Crit Care Med. 2019 Dec 15;200(12):1487-1495
pubmed: 31454263
Clin Transl Sci. 2008 Dec;1(3):200-8
pubmed: 19212447
N Engl J Med. 2018 Mar 1;378(9):819-828
pubmed: 29485926
Nephrol Dial Transplant. 2009 Nov;24(11):3265-8
pubmed: 19318357
Ann Clin Biochem. 2014 May;51(Pt 3):335-51
pubmed: 24518531
Clin J Am Soc Nephrol. 2013 Jul;8(7):1079-88
pubmed: 23599408
Am J Respir Crit Care Med. 2016 Feb 1;193(3):281-7
pubmed: 26398704
Br J Anaesth. 2018 Feb;120(2):274-283
pubmed: 29406176
Anaesth Intensive Care. 2018 Jan;46(1):79-87
pubmed: 29361260
Crit Care. 2010;14(5):R185
pubmed: 20950434
J Am Soc Nephrol. 2007 Feb;18(2):407-13
pubmed: 17229907
Anesth Analg. 1999 May;88(5):999-1003
pubmed: 10320158
Ann Surg. 2014 May;259(5):881-7
pubmed: 24253140
PLoS One. 2017 May 12;12(5):e0176292
pubmed: 28498856
Ann Surg. 2012 Jul;256(1):18-24
pubmed: 22580944
N Engl J Med. 2013 Sep 26;369(13):1243-51
pubmed: 24066745
Crit Care Med. 1985 Oct;13(10):818-29
pubmed: 3928249
Trials. 2017 Mar 16;18(1):129
pubmed: 28302179
Nephrol Dial Transplant. 2014 Jul;29(7):1301-11
pubmed: 24385545
Neurol India. 2018 Sep-Oct;66(5):1338-1344
pubmed: 30233000
Kidney Int. 2002 Jul;62(1):237-44
pubmed: 12081583
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Crit Care Med. 2014 Apr;42(4):e270-8
pubmed: 24335444
J Inflamm (Lond). 2013 Sep 24;10(1):29
pubmed: 24059479
J Am Soc Nephrol. 2011 Sep;22(9):1748-57
pubmed: 21836143
BMC Nephrol. 2019 Jun 3;20(1):200
pubmed: 31159750
Crit Care. 2004 Aug;8(4):R204-12
pubmed: 15312219
N Engl J Med. 2018 Mar 1;378(9):829-839
pubmed: 29485925
Clin J Am Soc Nephrol. 2012 May;7(5):844-50
pubmed: 22442182
Ann Surg. 2012 May;255(5):821-9
pubmed: 22470070
J Clin Invest. 1983 Mar;71(3):726-35
pubmed: 6826732