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February 13, 2013

Chloride-Restrictive Fluid Administration and Incidence of Acute Kidney Injury

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Department of Medicine, Denver Health, Denver, Colorado (ralbert@dhha.org).

JAMA. 2013;309(6):542. doi:10.1001/jama.2012.171505

To the Editor: Dr Yunos and colleagues1 reported that, compared with chloride-liberal intravenous fluid administration, chloride-restrictive fluid administration was associated with a decrease in the incidence of acute kidney injury and the need for renal replacement therapy. When evaluating the association of any intervention with renal function, potential differences in volume administered must be considered. It is difficult to compare the volume of fluid administered when colloid is given as opposed to crystalloid, but it is possible to compare the amount of sodium administered as a surrogate for volume.