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Comment & Response
April 12, 2016

Acute Kidney Injury With Buffered Crystalloids vs Saline Among ICU Patients

Author Affiliations
  • 1Department of Anesthesia, University Hospital Freiburg, Freiburg, Germany
JAMA. 2016;315(14):1519-1520. doi:10.1001/jama.2016.0148

To the Editor Dr Young and colleagues1 interpreted their findings as showing that the use of buffered crystalloids was not associated with a lower risk of AKI compared with normal saline. I am concerned with this interpretation because of numerous limitations of the study.

By study day 2, less than half of the initially randomized patients received study fluids, with a median volume of 176 mL to 199 mL; by study day 3, less than a third of patients received study fluids, with a median volume of 82 mL to 89 mL. The median volume administered throughout the observation period of 90 days was just 2000 mL in both groups. Before randomization, more than 60% of patients in both groups had received median amounts of buffered crystalloids of 1000 mL to 1200 mL. The interquartile ranges indicate that in individual patients, prerandomization volume might well have exceeded the total amount of subsequent study fluids, thereby obscuring any possible treatment effect.

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