Effects of Fluid Resuscitation With 0.9% Saline Versus a Balanced Electrolyte Solution on Acute Kidney Injury in a Rat Model of Sepsis*

Abstract

Objective To compare the acute effects of 0.9% saline versus a balanced electrolyte solution on acute kidney injury in a rat model of sepsis. Design Controlled laboratory experiment. Setting University laboratory. Subjects Sixty adult, male Sprague-Dawley rats. Interventions We induced sepsis by cecal ligation and puncture and randomized animals to receive fluid resuscitation with either 0.9% saline or Plasma-Lyte solution for 4 hours after 18 hours of cecal ligation and puncture (10 mL/kg in the first hour and 5 mL/kg in the next 3 hr). Blood and urine specimens were obtained from baseline, 18 hours after cecal ligation and puncture, immediately after 4 hours fluid resuscitation, and 24 hours later. We measured blood gas, plasma electrolytes, creatinine, interleukin-6, cystatin C, and neutrophil gelatinase-associated lipocalin concentrations. We also analyzed urine for cystatin C and neutrophil gelatinase-associated lipocalin. We used Risk, Injury, Failure, Loss and End-stage criteria for creatinine to assess severity of acute kidney injury. We observed all animals for survival up to 1 day after resuscitation. Surviving animals were killed for kidney histology. Finally, we carried out an identical study in 12 healthy animals. Measurements and Main Results Compared with Plasma-Lyte, 0.9% saline resuscitation resulted in significantly greater blood chloride concentrations (p < 0.05) and significantly decreased pH and base excess. Acute kidney injury severity measured by RIFLE criteria was increased with 0.9% saline compared with Plasma-Lyte resuscitation (p < 0.05), and these results were consistent with kidney histology and biomarkers of acute kidney injury. Twenty-four-hour survival favored Plasma-Lyte resuscitation (76.6% vs 53.3%; p = 0.03). Finally, in healthy animals, we found no differences between fluids and no evidence of acute kidney injury. Conclusion Volume resuscitation with Plasma-Lyte resulted in less acidosis and less kidney injury and improved short-term survival when compared with 0.9% saline in this experimental animal model of sepsis.

Intravenous balanced solutions: from physiology to clinical evidence

“…Over the years, more concern has been raised over other unwanted side effects of 0.9% NaCl intravenous administration as compared to balanced solutions [8,30], as different mechanisms underlying a potential Cl -toxicity have been postulated. Several reports have observed that Cl -mediates vascular smooth muscle cell Ca 2+ -dependent contraction [31], may modify vascular responses to vasoconstrictor agents in the kidney [32] and may affect plasma renin activity and systemic blood pressure [33].…”

“…Moreover, a study on septic rats resuscitated with intravenous administration of either 0.9% NaCl or a balanced solution (Plasma-Lyte), showed the development of hyperchloremic metabolic acidosis, as associated with an increased IL-6 levels, incident acute kidney injury (AKI) and a higher mortality rate in those receiving 0.9% NaCl [30]. Although the association between hyperchloremia and immune system dysfunction is far from proof of causality, it is worth mentioning that in a retrospective analysis of a large hospital claims database, patients receiving only 0.9% NaCl perioperatively showed a higher probability of developing a major postoperative infection, as compared to patients receiving only Plasma-Lyte [29].…”

Does fluid resuscitation with balanced solutions induce electrolyte and metabolic abnormalities? An in vitro assessment

“…Plasma-Lyte A as a calcium-free balanced crystalloid solution has been shown to produce lesser metabolic derangements in the population of trauma patients [12]. Zhou et al [13], in an experimental model of abdominal sepsis in rats, showed lesser metabolic acidosis and lower chloride concentration with Pasma-Lyte compared to NS. The authors showed also higher risk of acute kidney injury and mortality in the group receiving NS.…”

Aloe vera delays mortality, but does not attenuate kidney injury in septic mices

“…It was analyzed in the kidney the presence of glomerular and tubular necrosis, tubular inflammation, parenchymal edema, hyaline and hematic casts. Histopathological analysis was ranked scores: 0 (absent), 1 (mild), 2 (moderate) and 3 (severe) [14]. Histological abnormalities were assessed by a pathologist blinded to treatment group.…”