A 65-year-old man with chronic kidney disease undergoes emergency laparotomy for bowel perforation. Postoperatively, he requires ongoing fluid resuscitation. The SMART trial compared balanced crystalloids such as lactated Ringer's with normal saline in ICU patients. What was the primary finding?
- A Balanced crystalloids reduced the composite outcome of major adverse kidney events ✓
- B No difference in 30-day mortality between groups
- C Normal saline was associated with lower rates of acute kidney injury
- D Balanced crystalloids increased the risk of hyperchloremic metabolic acidosis
Correct answer: A. Balanced crystalloids reduced the composite outcome of major adverse kidney events
Explanation
The SMART trial found that balanced crystalloids reduced the composite outcome of major adverse kidney events, defined as death, new renal replacement therapy, or persistent renal dysfunction, compared with normal saline. Normal saline causes hyperchloremic metabolic acidosis due to its high chloride content, which can reduce renal blood flow. The mortality benefit was not statistically significant as a primary endpoint, though secondary analyses suggested benefit.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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