Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Internal Medicine, Central Hospital of Bolzano/Bozen, Bolzano/Bozen, Italy (Dr Wiedermann; email@example.com); and Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria (Dr Joannidis).
To the Editor: Dr Yunos and colleagues1 changed intensive care unit fluid management practices to decrease chloride exposure. Acute kidney injury and renal replacement therapy declined, with an adjusted odds ratio (OR) of 0.52 for both end points. The changes consisted of substituting lactated/balanced crystalloid and 20% albumin for 4% albumin, gelatin, and 0.9% saline. Which of these changes contributed to the improved renal outcomes could not be determined.
Wiedermann CJ, Joannidis M. Chloride-Restrictive Fluid Administration and Incidence of Acute Kidney Injury. JAMA. 2013;309(6):543-544. doi:10.1001/jama.2012.171508