• Jae-Sik Nam, Wook-Jong Kim, Wan-Woo Seo, Sang-Wook Lee, Kyung-Woon Joung, Ji-Hyun Chin, Dae-Kee Choi, and In-Cheol Choi.
• Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 1; 38 (9): 192319311923-1931.

ObjectivesTo determine whether balanced solutions can reduce the incidence of acute kidney injury after off-pump coronary artery bypass surgery compared with saline.DesignRandomized controlled trial.SettingSingle tertiary care center.ParticipantsPatients who underwent off-pump coronary artery bypass surgery between June 2014 and July 2020.InterventionsBalanced solution-based chloride-restrictive intravenous fluid strategy.Measurements And Main ResultsThe primary outcome was acute kidney injury within 7 postoperative days, as defined by the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of acute kidney injury was 4.4% (8/180) in the balanced group and 7.3% (13/178) in the saline group. The difference was not statistically significant (risk difference, -2.86%; 95% confidence interval [CI], -7.72% to 2.01%; risk ratio, 0.61, 95% CI, 0.26 to 1.43; p = 0.35). Compared with the balanced group, the saline group had higher levels of intraoperative serum chloride and lower base excess, which resulted in a lower pH.ConclusionsIn patients undergoing off-pump bypass surgery with a normal estimated glomerular filtration rate, the intraoperative balanced solution-based chloride-restrictive intravenous fluid administration strategy did not decrease the rate of postoperative acute kidney injury compared with the saline-based chloride-liberal intravenous fluid administration strategy.Copyright © 2024 Elsevier Inc. All rights reserved.

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