Abstract 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.
Sean P Collins合作论文数1Karen E Jackson合作论文数1Matthew W Semler合作论文数1Christina T Saunders合作论文数1
Ryan Linn Brown合作论文数RAND Corp, Santa Monica, CA USA1Self Wesley H合作论文数Dept Emergency Med, Vanderbilt Univ1
Gordon R Bernard合作论文数Department of Medicine, Vanderbilt University Medical Center;Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center1
Todd Rice合作论文数Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center1
Jonathan Casey合作论文数Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.1Li Wang合作论文数Department of Biostatistics, Vanderbilt University1
Nancy Wickersham合作论文数Department of Medicine, Vanderbilt University1Edward D Siew合作论文数1
Jeffrey Blume合作论文数School of Data Science, University of Virginia;Data Science Institute, Vanderbilt University1
