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Cited by 764Acute Kidney Injury ResearchHemodynamic Monitoring and TherapyTrauma, Hemostasis, Coagulopathy, Resuscitation

A Randomized, Controlled, Double-Blind Crossover Study on the Effects of 2-L Infusions of 0.9% Saline and Plasma-Lyte® 148 on Renal Blood Flow Velocity and Renal Cortical Tissue Perfusion in Healthy Volunteers

Chowdhury, Abeed H., Cox, Eleanor F., Francis, Susan T., Lobo, Dileep N.·2012·Annals of Surgery
DOI 10.1097/sla.0b013e318256be72
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Abstract

OBJECTIVE: We compared the effects of intravenous infusions of 0.9% saline ([Cl] 154 mmol/L) and Plasma-Lyte 148 ([Cl] 98 mmol/L, Baxter Healthcare) on renal blood flow velocity and perfusion in humans using magnetic resonance imaging (MRI). BACKGROUND: Animal experiments suggest that hyperchloremia resulting from 0.9% saline infusion may affect renal hemodynamics adversely, a phenomenon not studied in humans. METHODS: Twelve healthy adult male subjects received 2-L intravenous infusions over 1 hour of 0.9% saline or Plasma-Lyte 148 in a randomized, double-blind manner. Crossover studies were performed 7 to 10 days apart. MRI scanning proceeded for 90 minutes after commencement of infusion to measure renal artery blood flow velocity and renal cortical perfusion. Blood was sampled and weight recorded hourly for 4 hours. RESULTS: Sustained hyperchloremia was seen with saline but not with Plasma-Lyte 148 (P < 0.0001), and fall in strong ion difference was greater with the former (P = 0.025). Blood volume changes were identical (P = 0.867), but there was greater expansion of the extravascular fluid volume after saline (P = 0.029). There was a significant reduction in mean renal artery flow velocity (P = 0.045) and renal cortical tissue perfusion (P = 0.008) from baseline after saline, but not after Plasma-Lyte 148. There was no difference in concentrations of urinary neutrophil gelatinase-associated lipocalin after the 2 infusions (P = 0.917). CONCLUSIONS: This is the first human study to demonstrate that intravenous infusion of 0.9% saline results in reductions in renal blood flow velocity and renal cortical tissue perfusion. This has implications for intravenous fluid therapy in perioperative and critically ill patients. NCT01087853.

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  • Applying a PK/PD approach to antibiotic dosing requires support from knowledgeable clinician team members, use of a patient population-specific guideline document, use of therapeutic drug monitoring, and/or use of dosing software.

    “Applying a PK/PD approach to antibiotic dosing requires support from knowledgeable clinician team members (254), use of a patient population-specific guideline document (255), use of therapeutic drug monitoring (256), and/or use of dosing software (238,248).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [256]

  • Normal saline may cause hyperchloremic metabolic acidosis, renal vasoconstriction, increased cytokine secretion, and concern for acute kidney injury.

    “potential adverse effects that include hyperchloremic metabolic acidosis, renal vasoconstriction, increased cytokine secretion and concern about acute kidney injury (AKI) have led to increased interest in chloride-restrictive solutions, known as balanced or buffered solutions [326–330].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [326]

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Authors
Chowdhury, A. H., Cox, E. F., Francis, S. T., & Lobo, D. N.
Affiliations
  • Nottingham University Hospitals NHS Trust (GB)
  • University of Nottingham (GB)
  • National Institute for Health and Care Research (GB)
Corresponding author
  • Chowdhury, Abeed H.
  • Lobo, Dileep N.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-07
Volume
256
Issue
1
Pages
18-24
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/sla.0b013e318256be72
OpenAlex
W2014698393
Cited by
764
References
36
Citations by year
2026: 20 · 2025: 32 · 2024: 41 · 2023: 49 · 2022: 57 · 2021: 57 · 2020: 51 · 2019: 60 · 2018: 70 · 2017: 81 · 2016: 88 · 2015: 54 · 2014: 56 · 2013: 36 · 2012: 11
FWCI
39.65
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
Keywords
0.9% saline, Plasma-Lyte 148, hyperchloremia, renal blood flow velocity, renal cortical perfusion, intravenous fluid therapy, strong ion difference, urinary neutrophil gelatinase-associated lipocalin, renal hemodynamics, perioperative fluid management
MeSH terms
Adult, Blood Flow Velocity, Cardioplegic Solutions, Double-Blind Method, Gluconates, Humans, Infusions, Intravenous, Kidney, Magnetic Resonance Imaging, Male, Potassium Chloride, Sodium Chloride, Magnesium Chloride, Cross-Over Studies, Sodium Acetate, Young Adult

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