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To the Editor In the study by Dr Young and colleagues1 comparing kidney toxicity of a buffered crystalloid solution vs saline in patients admitted to the intensive care unit (ICU), acute kidney injury (AKI) was defined based solely on the serum creatinine criteria of the risk, injury, failure, loss, and end-stage renal failure (RIFLE) classification. The mean volumes of intravenous study and nonstudy fluids administered in 24 hours prior to enrollment and during the observation period were not significantly different between groups, but the ranges were variable. We would like to know whether the serum creatinine levels used for diagnosis of AKI in this study were adjusted for the fluid balance of patients. It has been shown that not adjusting serum creatinine levels for fluid balance in patients who are critically ill may underestimate the severity of AKI, whereas adjusting serum creatinine levels for fluid balance can improve recognition and staging of AKI.2,3
Xue FS, Li RP, Sun C. Acute Kidney Injury With Buffered Crystalloids vs Saline Among ICU Patients. JAMA. 2016;315(14):1518-1519. doi:10.1001/jama.2016.0151