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Comment & Response
April 12, 2016

Acute Kidney Injury With Buffered Crystalloids vs Saline Among ICU Patients—Reply

Author Affiliations
  • 1Medical Research Institute of New Zealand, Wellington, New Zealand
  • 2Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia
  • 3Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(14):1521. doi:10.1001/jama.2016.0157

In Reply The SPLIT trial enrolled 2278 patients and was predominantly funded by a Health Research Council of New Zealand grant of approximately US $130 000. Conducting a large-scale trial with a small budget required us to make pragmatic decisions about which outcome variables were most important.1 We chose not to include urine output criteria in our definition of AKI because increased urine output can occur concurrently with a rise in serum creatinine and an increased requirement for dialysis.2 Such an effect can lead to the erroneous conclusion that a nephrotoxic fluid that causes diuresis reduces AKI.3 We chose to focus on indices of renal function that are used in routine clinical care rather than adjusting creatinine for fluid balance4 or measuring renal biomarkers. We agree that biochemistry data would be informative and are undertaking a secondary analysis linking the SPLIT database to the Australian and New Zealand Intensive Care Society Adult Patient Database. This will provide access to biochemical data from the first 24 hours following ICU admission.