The Effect of Fluid Resuscitation With 0.9% Sodium Chloride Versus Balanced Crystalloid Solution on Renal Function of Sepsis Patients

Last updated: March 5, 2021
Sponsor: Chulalongkorn University
Overall Status: Completed

Phase

3

Condition

Renal Failure

Kidney Disease

Sepsis And Septicemia

Treatment

N/A

Clinical Study ID

NCT03277677
IRB.113/60
  • Ages 18-100
  • All Genders

Study Summary

The high chloride content of 0.9%sodium chloride (0.9%NaCl) leads to adverse pathophysiological effects in both animals and healthy human volunteers. Small randomized trials confirm that the hyperchloremic acidosis induced by 0.9%NaCl also occurs in patients. A strong signal is emerging from recent large propensity-matched and cohort studies for the adverse effects that 0.9% NaCl has on the clinical outcome in surgical and critically ill patients when compared with balanced crystalloids. Major complications are the increased incidences of acute kidney injury and the need for renal replacement therapy, and that pathological hyperchloremia may increase postoperative mortality.

Fluid resuscitation with 0.9% NaCl in animals with sepsis resulted in hyperchloremic metabolic acidosis, worsened AKI, and increased mortality when compared with resuscitation with a balanced crystalloid solution.

Furthermore, hyperchloremic acidosis also resulted in increased concentrations of circulating inflammatory mediators in an experimental model of severe sepsis in rats, with a dose-dependent increase in circulating interleukin-6, tumor necrosis factor-a, and interleukin-10 concentrations with increasing acidosis.

Thus, in this study, investigators compared the effects of a balanced crystalloid solution with 0.9% NaCl on the renal function in severe sepsis/septic shock patients. Investigators hypothesized that balanced crystalloid solution resuscitation would decrease AKI incidence and severity and would improve immunomodulatory effect when compared with 0.9% NaCl resuscitation.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Age ≥ 18 years old
  • Who need fluid resuscitation in the Emergency Room (ER).
  • Who have fulfilled the criteria for sepsis/septic shock within the previous 24 hoursaccording to sepsis is defined as life-threatening organ dysfunction caused by adysregulated host response to infection. o Patients with infection and resulted from a host's systemic inflammatory responsesyndrome (SIRS) to infection are defined as sepsis if meet the criteria 2 or more of
  • Temperature >38°C or <36°C
  • Heart rate >90/min
  • Respiratory rate >20/min or PaCo2 <32 mm Hg (4.3 kPa)
  • White blood cell count >12000/mm3 or <4000/mm3 or >10% immature bands.
  • Patient who have Septic shock is a subset of sepsis in which underlying circulatoryand cellular/metabolic abnormalities are profound enough to substantially increasemortality. o Patients with septic shock can be identified with a clinical construct of sepsiswith persisting hypotension requiring vasopressors to maintain MAP ≥65 mm Hg andhaving a serum lactate level >2 mmol/L (18 mg/dL) despite adequate volumeresuscitation.
  • AND where informed consent is obtainable either from the patient or by proxy (firstdegree relative, spouse) if patients aren't in fully conscious status (eg.comatose,drowsiness, irritable). Exclusion criteria

Exclusion

Exclusion Criteria:

  • Patients with chronic kidney disease (CKD) defined by baseline serum creatinine > 2.0in male and 1.5 in female.
  • Patients with End stage renal disease (ESRD) with or without renal replacementtherapy.
  • Patients with active cardiac disease : severe valvular heart, cardiomyopathy,decompensated heart failure NYHA II-IV, severe pulmonary hypertension.
  • HIV/AIDs Patients.
  • Allergy towards 0.9% NaCl or Ringer's Acetate.
  • Any form of renal replacement therapy.
  • Intracranial bleeding within current hospitalization.
  • Therapy with corticosteroid or non steroidal anti-inflammatory substance.
  • Patients who predicted not to survive more than 24 hours.
  • Pregnant and lactating patients.
  • Withdrawal of active therapy.

Study Design

Total Participants: 116
Study Start date:
July 01, 2017
Estimated Completion Date:
March 01, 2021

Connect with a study center

  • Chulalongkorn university

    Bangkok, 10330
    Thailand

    Site Not Available

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.