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Comment & Response |

Acute Kidney Injury With Buffered Crystalloids vs Saline Among ICU Patients—Reply

Paul Young, FCICM1; Michael Bailey, PhD2; Rinaldo Bellomo, FCICM3
[+] Author Affiliations
1Medical Research Institute of New Zealand, Wellington, New Zealand
2Australian and New Zealand Intensive Care Research Center, Monash University, Melbourne, Victoria, Australia
3Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
JAMA. 2016;315(14):1521. doi:10.1001/jama.2016.0157.
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In Reply The SPLIT trial enrolled 2278 patients and was predominantly funded by a Health Research Council of New Zealand grant of approximately US $130 000. Conducting a large-scale trial with a small budget required us to make pragmatic decisions about which outcome variables were most important.1 We chose not to include urine output criteria in our definition of AKI because increased urine output can occur concurrently with a rise in serum creatinine and an increased requirement for dialysis.2 Such an effect can lead to the erroneous conclusion that a nephrotoxic fluid that causes diuresis reduces AKI.3 We chose to focus on indices of renal function that are used in routine clinical care rather than adjusting creatinine for fluid balance4 or measuring renal biomarkers. We agree that biochemistry data would be informative and are undertaking a secondary analysis linking the SPLIT database to the Australian and New Zealand Intensive Care Society Adult Patient Database. This will provide access to biochemical data from the first 24 hours following ICU admission.


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April 12, 2016
Kumaresh Venkatesan, FRCA, EDIC, FFICM
1Khoo Teck Puat Hospital, Anaesthesia and Surgical Intensive Care, Singapore
JAMA. 2016;315(14):1519. doi:10.1001/jama.2016.0142.
April 12, 2016
Alexander H. Flannery, PharmD; Angel O. Coz-Yataco, MD
1Medical Intensive Care Unit, University of Kentucky HealthCare, Lexington
2Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky HealthCare, Lexington
JAMA. 2016;315(14):1519. doi:10.1001/jama.2016.0145.
April 12, 2016
Hans-Joachim Priebe, MD, FRCA, FFCAI
1Department of Anesthesia, University Hospital Freiburg, Freiburg, Germany
JAMA. 2016;315(14):1519-1520. doi:10.1001/jama.2016.0148.
April 12, 2016
Fu S. Xue, MD; Rui P. Li, MD; Chao Sun, MD
1Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
JAMA. 2016;315(14):1518-1519. doi:10.1001/jama.2016.0151.
April 12, 2016
Alexandre B. Cavalcanti, MD, PhD; Lucas P. Damiani, MSc; Fernando A. Bozza, PhD
1Research Institute Hospital do Coração, São Paulo, Brazil
2Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
JAMA. 2016;315(14):1520. doi:10.1001/jama.2016.0154.
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