SPLIT Trial

Effect of 0.9% saline versus buffered crystalloid solution on renal complications in ICU patients. Based on concerns that renal artery blood flow (and hence nephron perfusion) falls to greater

Bellomo n 2012 demonstrated an association between chloride rich fluid and AKI

  • Changed from gelatin, albumin and 0.9% saline to balanced
  • Could be that gelatinS were harmful, rather than saline

Hence SPLIT

Double-blind, cluster randomised, double-crossover trial

4 ICUs in New Zealand April til October 2014

  • 3 general medical and surgical
  • 1 predominantly cardiothoracic and vascular surgery

Conducted in all centres with with each centre using 0.9% saline or Plasmalyte for blocks of 7 weeks x 2

2278 patients included

  • 1152 Plasmlayte treated and analysed
  • 1100 0.9% saline treated and analysed

99% of eligible patients were enrolled, followed up and analysed

Treatment groups had similar baseline characteristics

  • About 60 years
  • 2/3 male
  • 42% cardiac surgery
  • 60% elective surgical
  • APACHE-II around 14
  • Approx 60% had received buffered crystalloid pre-ICU and 30% saline

No difference in incidence of AKI (9.6% in Plasmalyte, 9.2% in 0.9% saline)

No difference in need for RRT

Need for RRT

No difference in any of pre-defined subgroups (APACHE high or low, centre, sepsis, cardiac surgery)

Subgroups

No difference in mortality although not powered for that

Conclusion: Among patients receiving crystalloid fluid therapy in the ICU, use of a buffered crystalloid compared with saline did not reduce the risk of AKI.

Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit

Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults