Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline.

Among the 7,942 patients in the balanced-crystalloids group, 1,139 had a major adverse kidney event, as compared with 1,211 of 7,860 patients in the saline group. The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively.

In a pragmatic, cluster-randomized, multiple-crossover trial conducted in 5 ICUs at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted.

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