Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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
See this image and copyright information in PMC

Comment in

References

    1. Marui A, Okabayashi H, Komiya T, Tanaka S, Furukawa Y, Kita T, et al. Benefits of off-pump coronary artery bypass grafting in high-risk patients. Circulation. 2012;126:S151–7. - PubMed
    1. Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, et al. Off-pump vs conventional coronary artery bypass grafting: Early and 1-year graft patency, cost, and quality-of-life outcomes: A randomized trial. JAMA. 2004;291:1841–9. - PubMed
    1. Afilalo J, Rasti M, Ohayon SM, Shimony A, Eisenberg MJ. Off-pump vs. On-pump coronary artery bypass surgery: An updated meta-analysis and meta-regression of randomized trials. Eur Heart J. 2012;33:1257–67. - PubMed
    1. Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:797–808. - PubMed
    1. Garg AX, Devereaux PJ, Yusuf S, Cuerden MS, Parikh CR, Coca SG, et al. Kidney function after off-pump or on-pump coronary artery bypass graft surgery: A randomized clinical trial. JAMA. 2014;311:2191–8. - PubMed

Publication types

MeSH terms