Claure-Del Granado Rolando, Prudencio-Ribera Vania C, Gupta Vineet, Yang Jason, Kashani Kianoush, Malhotra Rakesh
Division of Nephrology, Department of Medicine, Hospital Obrero No. 2 - Caja Nacional de Salud (CNS) Universidad Mayor de San Simon, Cochabamba, BOL.
Pulmonology, University Hospital of Toledo, Toledo, ESP.
Cureus. 2023 Jul 19;15(7):e42127. doi: 10.7759/cureus.42127. eCollection 2023 Jul.
Background Administration of intravenous (IV) solutions constitutes a key component of acute kidney injury (AKI) management. However, the optimal IV fluid solution in the setting of AKI remains uncertain. In this study, we assessed whether the use of bicarbonate-containing solution in patients with established AKI is associated with early renal recovery as compared to bicarbonate-free solutions. Methods We performed an open-label observational pilot study in 59 patients with established AKI. IV fluid solutions that were used include bicarbonate-based solution with low chloride content (80 mEq/L of 8% sodium bicarbonate in a solution that contains 77 mEq/L of sodium, 77 mEq/L of chloride and 25 g/L of glucose) or solutions without bicarbonate with high chloride content (0.9% normal saline, 0.45% half-saline, normal ringer, or 4% succinylated gelatine). We evaluated the association of IV fluids type with renal recovery. Results The median age of study participants was 66 years (inter-quartile range (IQR) 37-85), and 59% (n=35) were men. The prevalence of diabetes and chronic kidney disease (CKD) stages 1-3 were 34% (n=20) and 39% (n=23), respectively. Patients who received bicarbonate-based IV solutions had a greater reduction of serum creatinine (sCr) per day (delta sCr) as compared with patients who received bicarbonate-free solutions (-0.29±0.47 vs. 0.07±0.42; p=0.007). The renal recovery was faster in patients who received bicarbonate-based solutions as compared to the bicarbonate-free group (days from peak sCr to baseline sCr: 5.6±2.1 vs. 7.6±2.8; p < 0.001, respectively). Conclusions We observed faster renal recovery in patients with established AKI who received the bicarbonate-based solution with low chloride content. Our study findings require confirmation in larger cohorts.
背景 静脉输注溶液是急性肾损伤（AKI）治疗的关键组成部分。然而，AKI时最佳的静脉输液溶液仍不确定。在本研究中，我们评估了已确诊AKI的患者使用含碳酸氢盐溶液与不含碳酸氢盐溶液相比，是否与早期肾脏恢复相关。方法 我们对59例已确诊AKI的患者进行了一项开放标签的观察性试点研究。使用的静脉输液溶液包括低氯含量的碳酸氢盐基溶液（8%碳酸氢钠80 mEq/L，溶液中含77 mEq/L钠、77 mEq/L氯和25 g/L葡萄糖）或高氯含量的无碳酸氢盐溶液（0.9%生理盐水、0.45%半生理盐水、复方氯化钠或4%琥珀酰明胶）。我们评估了静脉输液类型与肾脏恢复的相关性。结果 研究参与者的中位年龄为66岁（四分位间距（IQR）37 - 85），59%（n = 35）为男性。糖尿病患病率和慢性肾脏病（CKD）1 - 3期分别为34%（n = 20）和39%（n = 23）。与接受无碳酸氢盐溶液的患者相比，接受碳酸氢盐基静脉输液溶液的患者血清肌酐（sCr）每日降低幅度更大（ΔsCr）（-0.29±0.47 vs. 0.07±0.42；p = 0.007）。与无碳酸氢盐组相比，接受碳酸氢盐基溶液的患者肾脏恢复更快（从sCr峰值到基线sCr的天数：5.6±2.1 vs. 7.6±2.8；p < 0.001）。结论 我们观察到，已确诊AKI且接受低氯含量碳酸氢盐基溶液的患者肾脏恢复更快。我们的研究结果需要在更大的队列中得到证实。
