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Randomized Controlled Trial
. 2018 Oct-Dec;21(4):413-418.
doi: 10.4103/aca.ACA_230_17.

A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries

K Bhaskaran  1 , Ganapathy Arumugam  1 , P V Vinay Kumar  2
Affiliations
Randomized Controlled Trial

A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries

K Bhaskaran et al. Ann Card Anaesth. 2018 Oct-Dec.

Abstract

Context and aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Previous studies suggest important differences related to intravenous fluid (IVF) chloride content and renal function. We hypothesize that perioperative use of chloride restricted IVFs may decrease incidence and severity of postoperative AKI in patients undergoing OPCABG.

Methods: Six hundred patients were randomly divided into two groups of 300 each. In Group A (n = 300), chloride liberal IVFs, namely, hydroxyethyl starch (130/0.4) in 0.9% normal saline (Voluven), 0.9% normal saline, and Ringer's lactate were used for perioperative fluid management. In Group B (n = 300), chloride-restricted IVFs, namely, hydroxyethyl starch (130/0.4) in balanced colloid solution (Volulyte) and balanced salt crystalloid solution (PlasmaLyte A), were used for perioperative fluid management. Serum creatinine values were taken preoperatively, postoperatively at 24 h and at 48 h. Postoperative AKI was determined by AKI network (AKIN) criteria.

Results: In Group A, 9.2% patients and in Group B 4.6% patients developed Stage-I AKI determined by AKIN criteria which was statistically significant (P < 0.05).

Conclusion: Perioperative use of chloride restricted IVF was found to decrease incidence of postoperative AKI. The use of chloride liberal IVF was associated with hyperchloremic metabolic acidosis.

Keywords: Acute kidney injury; hyperchloremic acidosis; off-pump coronary bypass grafting.

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Conflict of interest statement

There are no conflicts of interest

Figures

Graph 1
Graph 1
Comparison of mean pH at different time points
Graph 2
Graph 2
Comparison of mean bicarbonate at different time points
Graph 3
Graph 3
Comparison of mean base exces at different time points
Graph 4
Graph 4
Comparison of mean serum chloride at different time points
Graph 5
Graph 5
Comparison of mean strong ion difference at different time points
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