Intravenous saline use causes more kidney complications and decreases survival rates compared with balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A [Baxter]), according to researchers at Vanderbilt University Medical Center, in Nashville, Tenn.
The researchers found that patients experience better outcomes when given the balanced crystalloids, which most closely resemble components of the liquid part of blood, than when given saline, which contains higher amounts of sodium chloride. The findings were published in two studies this week in The New England Journal of Medicine ([Epub Feb 27, 2018], doi: 10.1056/NEJMoa1711584 and doi: 10.1056/NEJMoa1711586).
Vanderbilt also announced that it would immediately implement changes to its IV fluid management practices, specifically using less saline.
“Our results suggest that using primarily balanced fluids should prevent death or severe kidney dysfunction for hundreds of Vanderbilt patients and tens of thousands of patients across the country each year,” said Matthew Semler, MD, MSc, a co-author and an assistant professor of medicine at Vanderbilt University School of Medicine, in a press release.
The researchers divided more than 15,000 intensive care patients and more than 13,000 emergency department patients into two groups to receive either saline or the balanced fluids if IV fluids were required, according to the university release. They found a 1% reduction in incidences of serious kidney problems or death for the balanced fluids group compared with the saline group.
“When we say a 1 percent reduction that means thousands and thousands of patients would be better off,” said Wesley Self, MD, MPH, a co-author and an associate professor of emergency medicine at Vanderbilt University School of Medicine, in the press release.