Hypothesis: The use of balanced crystalloids would result in a lower overall incidence of death, new renal-replacement therapy, and persistent renal dysfunction compared to saline.
Results: 15,802 patients in 5 ICUs randomized to balanced crystalloids or saline. In the balanced crystalloid group, 1139 (14.3%) had an incident of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline compared to 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04).
Strengths: Large sample size; patients randomized to groups early in hospital course; minimal exclusion of potential subjects
Weaknesses: Single-center; physicians not blinded; the components of the composite outcome were not individually significantly different; notable number of deviations from the protocol
Key Point: Balanced crystalloids may be preferred to saline to reduce the risk of renal complications in critically-ill patients.