• Nathan M Lee, Lev Deriy, Timothy R Petersen, Vallabh O Shah, Michael P Hutchens, and Neal S Gerstein.
• Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
• J. Cardiothorac. Vasc. Anesth. 2019 Feb 1; 33 (2): 348356348-356.

ObjectiveAdministration of excess chloride in 0.9% normal saline (NS) decreases renal perfusion and glomerular filtration rate, thereby increasing the risk for acute kidney injury (AKI). In this study, the effect of NS versus Isolyte use during cardiac surgery on urinary levels of tissue inhibitor of metalloproteinase 2 and insulin-like growth factor-binding protein 7 [TIMP-2] × [IGFBP7] and postoperative risk of AKI were examined.DesignProspective, randomized, and single-blinded trial.SettingSingle university medical center.ParticipantsThirty patients over 18 years without chronic renal insufficiency or recent AKI undergoing elective cardiac surgery.InterventionsSubjects were randomized to receive either NS or Isolyte during the intraoperative period.Measurements And Main ResultsThe primary outcome was the change in urinary levels of [TIMP2] × [IGFBP7] from before surgery to 24 hours postoperatively. Secondary outcomes included serum creatinine pre- and postoperatively at 24 and 48 hours, serum chloride pre- and postoperatively at 24 and 48 hours, need for dialysis prior to discharge, and arterial pH measured 24 hours postoperatively. Sixteen patients received NS and 14 patients received Isolyte. Three patients developed AKI within the first 3 postoperative days, all in the NS group. The authors found increases in [TIMP-2] × [IGFBP7] in both groups. However, the difference in this increase between study arms was not significant (p = 0.92; -0.097 to 0.107).ConclusionThe authors observed no change in urinary [TIMP-] × [IGFBP7] levels in patients receiving NS versus Isolyte during cardiac surgery. Future larger studies in patients at higher risk for AKI are recommended to evaluate the impact of high- versus lower-chloride solutions on the risk of postoperative AKI after cardiac surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

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