In noncritcially ill adult patients, treatment with intravenous balanced crystalloids, instead of saline, resulted in a slightly lower incidence of major adverse kidney events within 30 days, according to a new study conducted by researchers from Vanderbilt University, TN. 

The SALT-ED trial (Saline against Lactated Ringer’s or Plasma-Lyte in the Emergency Department) lasted 16 months and involved 13,347 patients; 6,708 (50.3%) were assigned to balanced crystalloids and 6,639 (49.7%) were assigned to saline. Most balanced crystalloids were administered as lactated Ringer’s solution (95.3%), with a small percentage administered as Plasma-Lyte A (4.7%). 

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The results showed no difference in the number of hospital-free days (primary outcome) between either group (median 25 days in each group, odds ratio with balanced crystalloids, 0.98; 95% CI: 0.92 to 1.04; P=0.41). However, the balanced crystalloids group had a lower incidence of major adverse kidney events within 30 days vs the saline group, 4.7% vs. 5.6%, respectively (aOR, 0.82; 95% CI: 0.70 to 0.95; P=0.01). 

The results have prompted a change in practice toward using primarily balanced fluids instead of saline at Vanderbilt University Medical Center. “Because balanced fluids and saline are similar in cost, the finding of better patient outcomes with balanced fluids in two large trials has prompted a change in practice at Vanderbilt toward using primarily balanced fluids for intravenous fluid therapy,” said study author Matthew Semler, MD, MSc, professor of Medicine at Vanderbilt University. 

The incidence of major adverse events were all lower in the balanced crystalloids group vs saline group: death (1.4% vs. 1.6%), new renal-replacement therapy (0.3% vs. 0.5%) and final serum creatinine ≥200% (3.3% vs 4.5%). For stage 2 or higher acute kidney injury, the incidence was 7.2% and 8.6% for balanced cystalloids and saline, respectively. 

A separate trial (SMART) conducted concurrently in critically ill patients admitted to the ICU from the ER showed results consistent with the SALT-ED trial. 

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