ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 2 (2025), PERIOPERATIVE MANAGEMENT
No. 2 (2025)
PERIOPERATIVE MANAGEMENT

The effect of the balanced crystalloid solution on kidney function in early postoperative period following high-risk elective abdominal surgery: a randomized controlled pilot study

Published 30.04.2025
E.B. Lochekhina
Northern State Medical University, Arkhangelsk, Russia; City Clinical Hospital No. 1 named after E.E Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0001-5431-8784
Y.Yu. Ilyina
City Clinical Hospital No. 1 named after E.E Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0003-2538-4656
L.N. Rodionova
City Clinical Hospital No. 1 named after E.E Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0001-6548-4905
M.M. Sokolova
Northern State Medical University, Arkhangelsk, Russia; City Clinical Hospital No. 1 named after E.E Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0002-6705-5124
Vsevolod V. Kuzkov
Northern State Medical University, Arkhangelsk, Russia; City Clinical Hospital No. 1 named after E.E Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0002-8191-1185
M.Yu. Kirov
Northern State Medical University, Arkhangelsk, Russia; City Clinical Hospital No. 1 named after E.E Volosevich, Arkhangelsk, Russia
https://orcid.org/0000-0002-4375-3374
PDF_2025-2-86-98 (Russian)

Keywords

acute kidney injury
, neutrophil gelatinase-associated lipocalin (NGAL)
proenkephalin (pro-ENK)
balanced crystalloids
saline solution
chlorides

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Lochekhina E.B., Ilyina Y.Y., Rodionova L.N., Sokolova M.M., Kuzkov V.V., Kirov M.Y. The effect of the balanced crystalloid solution on kidney function in early postoperative period following high-risk elective abdominal surgery: a randomized controlled pilot study. Annals of Critical Care. 2025;(2):86–98. doi:10.21320/1818-474X-2025-2-86-98.
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Abstract

INTRODUCTION: An excessive load of chloride and sodium with crystalloids as well as hyperchloremia may modulate the inflammatory response, provoke fluid retention and renal disfunction. Balanced crystalloids (BC) may reduce the risk of postoperative acute kidney injury (AKI). OBJECTIVES: To assess the effect of BC on glomerular and tubular kidney function in the early postoperative period after high-risk surgery. MATERIAL AND METHODS: 30 patients were enrolled into a pilot study and randomly assigned to one of two groups: the control group (NS; NaCl 0.9 %) and the BC group. Demographic parameters, co-morbidity, hemodynamic and laboratory data, length of ICU stay were evaluated. The risk and severity of AKI were assessed with the markers of glomerular and/or tubular damage: neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (pro-ENK). RESULTS: A postoperative increase in creatinine reaching a cut-off for AKI stage 1 according to the Kidney Disease Improving Global Outcomes (KDIGO) staging system was not observed in the NS group, whereas in the BC group that was registered in one (6.7 %) and two cases (13 %) at 6 and 48 hours, respectively. The NS group demonstrated significantly higher serum NGAL concentrations at 6 and 48 hours (p = 0.02 and p = 0.003, respectively) and urine NGAL at 6 hours (p = 0.03) compared with the BC group. At 48 hours, the BC group showed a correlation between serum and urine pro-ENK (rho = 0.57), as well as between urine pro-ENK and NGAL (rho = 0.72; p < 0.05). In the NS group, a significant correlation was obtained between the fractional sodium excretion (FENa) and urine NGAL at 0 hours (rho=0.84) and 6 hours (rh =0.67) and in the BC group — between FENa and serum pro-ENK at 6 hours (rho=0.59). CONCLUSIONS: In high-risk surgery the use of BC is associated with a transient decrease in biomarkers of renal dysfunction without manifesting acute kidney injury.

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References

  1. 1. Bell S., Prowle J. Postoperative AKI — prevention is better than cure? Journal of the American Society of Nephrology 2019; 30(1): 4–6. DOI: 10.1681/ASN.2018111127
  2. 2. Boyer N., Eldridge J., Prowle J.R., Forni L.G. Postoperative Acute Kidney Injury. Clinical Journal of the American Society of Nephrology 2022; 17 (10): 1535–45. DOI: 10.2215/CJN.16541221
  3. 3. Grams M.E., Sang Y., Coresh J. et al. Acute kidney injury after major surgery: a retrospective analysis of veteran’s health administration data. American Journal of Kidney Diseases 2016; 67(6): 872–880. DOI: 10.1053/j.ajkd.2015.07.022
  4. 4. Malbrain M.L.N.G., Langer T., Annane D. et al. Intravenous fluid therapy in the perioperative and critical care setting: Executive summary of the International Fluid Academy (IFA). Annals of Intensive Care 2020; 10(1): 64. DOI: 10.1186/s13613-020-00679-3
  5. 5. Cecconi M., Hofer C., Teboul J.-L. et al. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Medicine. 2015; 41(9): 1529–37. DOI: 10.1007/s00134-015-3850-x
  6. 6. Myles P.S., Bellomo R., Corcoran T. et al. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. New England Journal of Medicine 2018; 378(24): 2263–74. DOI: 10.1056/NEJMoa1801601
  7. 7. Garg A.X., Cuerden M., Aguado H. et al. Effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury: a clinical research protocol for a substudy of the POISE-3 randomized clinical trial. Canadian Journal of Kidney Health and Disease 2022; 9: 1–9. DOI: 10.1177/20543581211069225
  8. 8. Vanmassenhove J., Glorieux G., Lameire N. et al. Influence of severity of illness on neutrophil gelatinase-associated lipocalin performance as a marker of acute kidney injury: a prospective cohort study of patients with sepsis. BMC Nephrology 2015; 16(1): 18. DOI:10.1186/s12882-015-0003-y
  9. 9. Barhight M.F., Brinton J.T., Soranno D.E. et al. Effects of hyperchloremia on renal recovery in critically ill children with acute kidney injury. Pediatric Nephrology 2020; 35(7): 1331–9. DOI: 10.1007/s00467-020-04513-7
  10. 10. Gwak D.-S., Chung I., Kim B-K. et al. High chloride burden and clinical outcomes in critically ill patients with large hemispheric infarction. Frontiers in Neurology 2021; 12: 604–86. DOI: 10.3389/fneur.2021.604686
  11. 11. Toyonaga Y., Kikura M. Hyperchloremic acidosis is associated with acute kidney injury after abdominal surgery. Nephrology 2017. 22(9): 720–7. DOI:10.1111/nep.12840
  12. 12. Astapenko D., Navratil P., Pouska J., Cerny V. Clinical physiology aspects of chloremia in fluid therapy: a systematic review. Perioperative Medicine 2020; 9(1): 40. DOI: 10.1186/s13741-020-00171-3
  13. 13. Monnet X., Lai C., Teboul J.-L. How I personalize fluid therapy in septic shock? Critical Care 2023; 27(1): 123. DOI: 10.1186/s13054-023-04363-3
  14. 14. Oh T.K., Song I.-A. et al. Hyperchloremia and postoperative acute kidney injury: a retrospective analysis of data from the surgical intensive care unit. Critical Care 2018; 22(1): 277. DOI:10.1186/s13054-018-2216-5
  15. 15. Claure-Del Granado R., Mehta R.L. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016; 17(1): 109. DOI: 10.1186/s12882-016-0323-6
  16. 16. van Regenmortel N., Moers L., Langer T. et al. Fluid-induced harm in the hospital: look beyond volume and start considering sodium. From physiology towards recommendations for daily practice in hospitalized adults. Annals of Intensive Care 2021; 11(1): 79. DOI: 10.1186/s13613-021-00851-3
  17. 17. Vignarajah M., Berg A., Abdallah Z. et al. Intraoperative use of balanced crystalloids versus 0.9 % saline: a systematic review and meta-analysis of randomised controlled studies. British Journal of Anaesthesia 2023; 131(3): 463–71. DOI: 10.1016/j.bja.2023.05.029
  18. 18. Заболотских И.Б., Григорьев Е.В., Афончиков В.С. и др. Гиповолемический шок у взрослых. Клинические рекомендации Общероссийской общественной организации «Федерация анестезиологов и реаниматологов». Вестник интенсивной терапии имени А.И. Салтанова. 2024; 4: 7–39. [Zabolotskikh I.B., Grigoriev E.V., Afonchikov V.S. et al. Hypovolemic shock in adults. Guidelines of the All-Russian Public Organization «Federation of Anesthesiologists and Reanimatologists». Annals of Critical Care 2024; 4: 7–39. (In Russ)]. DOI: 10.21320/1818-474X-2024-4-7-39
  19. 19. Лейдерман И.Н., Грицан А.И., Заболотских И.Б. и др. Периоперационная нутритивная поддержка. Методические рекомендации Федерации анестезиологов и реаниматологов. Вестник интенсивной терапии им. А.И. Салтанова. 2021; (4): 7–20. [Leyderman I.N., Gritsan A.I., Zabolotskikh I.B. et al. Perioperative nutritional support. Clinical practice recommendations of the national «Federation of Anesthesiologists and Reanimatologists». Annals of Critical Care 2021; (4): 7–20. (In Russ)]. DOI: 10.21320/1818-474X-2021-4-7-20
  20. 20. Бобовник С.В., Горобец Е.С., Заболотских И.Б. и др. Периоперационная инфузионная терапия у взрослых. Анестезиология и реаниматология 2021; (4): 17–33. [Bobovnik S.V., Gorobets E.S., Zabolotskikh I.B. et al. Perioperative fluid therapy in adults. Russian Journal of Anesthesiology and Reanimatology 2021; (4): 17–33. (In Russ)]. DOI: 10.17116/anaesthesiology20210417
  21. 21. Evans L., Rhodes A., Alhazzani W. et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine 2021; 47(11): 1181–1247. DOI: 10.1007/s00134-021-06506-y
  22. 22. Hammond D.A., Peksa G.D., Rech M.A. Balanced crystalloids in sepsis: are we there yet? American Journal of Respiratory and Critical Care Medicine 2020; 201(9): 1162–3. DOI: 10.1164/rccm.202001-0077le
  23. 23. De Backer D., Cecconi M., Lipman J. et al. Challenges in the management of septic shock: a narrative review. Intensive Care Medicine 2019; 45(4): 420–33. DOI: 10.1007/s00134-019-05544-x
  24. 24. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024; 105(4S): S117–S314. DOI: 10.1016/j.kint.2023.10.018
  25. 25. Вельков В.В. Цистатин С и NGAL — маркеры преклинической ренальной дисфункции и субклинического острого повреждения почек. Лабораторная служба 2015; 4(2): 38–43. [Velkov V.V. Cystatin C and NGAL — the Markers of Preclinical Renal Dysfunction and Subclinical Acute Kidney Injury. Laboratory service 2015; 4(2): 38–43. (In Russ)]. DOI: 10.17116/labs20154238-43
  26. 26. Danquah M., Owiredu W.K.B.A., Jnr B.A.E. et al. Diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for detection of renal failure in hypertensives: a case–control study in a regional hospital in Ghana. BMC Nephrology 2023; 24(1): 114. DOI: 10.1186/s12882-023-03120-6
  27. 27. Haase M., Devarajan P., Haase-Fielitz A. et al. The outcome of Neutrophil Gelatinase-Associated Lipocalin-Positive Subclinical Acute Kidney Injury. Journal of the American College of Cardiology 2011; 57(17): 1752–61. DOI: 10.1016/j.jacc.2010.11.051
  28. 28. Lin L.-C., Chuan M.-H., Liu J.-H. et al. Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis. Critical Care 2023; 27(1): 481. DOI: 10.1186/s13054-023-04747-5
  29. 29. Казаченко А.В., Войтко Д.А., Просянников М.Ю. и др. Современные маркеры определения функциональной способности почек в урологической практике. Экспериментальная и клиническая урология 2023; 16(1): 174–87. [Kazachenko A.V., Voitko D.A., Prosyannikov M.Yu. et al. Modern markers for determining kidney function in urological practice. Experimental and Clinical Urology. 2023; 16(1): 174–87. (In Russ)]. DOI: 10.29188/2222-8543-2023-16-1-174-187
  30. 30. Каюков И.Г., Галкина О.В., Тимшина Е.И. и др. Креатинин в современной оценке функционального состояния почек (Обзор литературы и собственные данные). Нефрология 2020; 24(4): 21–36. DOI: 10.36485/1561-6274 2020-24-4-21-36 [Kayukov I.G., Galkina O.V., Timshina E.I. et al. Creatinine in the modern evaluation of the kidneys functional condition (literature review and own data). Nephrology. 2020; 24(4): 21–36. DOI: 10.36485/1561-6274 2020-24-4-21-36 (In Russ)]
  31. 31. Prowle J.R., Forni L.G., Bell M. et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative. Nature Reviews Nephrology 2021; 17(9): 605–18. DOI: 10.1038/s41581-021-00418-2
  32. 32. Mok, V., Nixon, J., Hu, J., Ma D. The impact of perioperative acute kidney injury/failure on short and long surgical outcomes. Anesthesiology and Perioperative Science. 2023; 1(2): 9. DOI: 10.1007/s44254-022-00001-3
  33. 33. Rodrigues C.E., Endre Z.H. Definitions, phenotypes, and subphenotypes in acute kidney injury-Moving towards precision medicine. Nephrology 2023; 28(2): 83–96. DOI: 10.1111/nep.14132
  34. 34. Pickkers P., Darmon M., Hoste E. et al. Acute kidney injury in the critically ill: an updated review on pathophysiology and management. Intensive Care Medicine 2021; 47(8): 835–50. DOI:10.1007/s00134-021-06454-7
  35. 35. Wang B., Schub M., Ortiz-Melo D.I., Barisoni L. Paraneoplastic cast nephropathy associated with pancreatic acinar cell carcinoma: a kidney biopsy teaching case. kidney medicin. 2024; 6(10): 100887. DOI: 10.1016/j.xkme.2024.100887
  36. 36. Langer T., Ferrari M., Zazzeron L., et al. Effects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components. Anaesthesiology Intensive Therapy 2014; 46(5): 350–60. DOI: 10.5603/AIT.2014.0059
  37. 37. Vinay Kumar P. Bhaskaran K., Arumugam G. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries. Annals of Cardiac Anaesthesia 2018; 21(4): 413–18. DOI: 10.4103/aca.aca_230_17
  38. 38. Brookes E.M., Power D.A. Elevated serum urea-to-creatinine ratio is associated with adverse inpatient clinical outcomes in non-end stage chronic kidney disease. Scientific Reports 2022; 12(1): 20827. DOI: 10.1038/s41598-022-25254-7
  39. 39. Darmon M., Vincent F., Dellamonica J. et al. Diagnostic performance of fractional excretion of urea in the evaluation of critically ill patients with acute kidney injury: a multicenter cohort study. Critical Care 2011; 15(4): R178. DOI: 10.1186/cc10327
  40. 40. Cullen M., Jhanji S., Pearse R.M., Fitzgibbon M.C. Neutrophil gelatinase-associated lipocalin and albuminuria as predictors of acute kidney injury in patients treated with goal-directed haemodynamic therapy after major abdominal surgery. Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 2014; 51(3): 392–9. DOI: 10.1177/0004563213507438
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