Renal failure...LR better than NaCl

Traditionally balanced salt solutions  like LR were avoided in Renal failure patients  because of concerns regarding accumulation of potassium in renal failure.Keep in mind LR contains only 4 meq of potassium....

However, a study by O’Malley et al. demonstrated a 20% absolute risk increase (number needed to treat: 5) for hyperkalemia in patients undergoing renal transplantation who were administered saline rather than lactated Ringer solution.

Moreover, there was a 30% incidence of metabolic acidosis, requiring treatment, in the saline group, versus 0% in the lactated Ringer group.

Chloride is involved with regulation of renal vascular tone. Hansen demonstrated that potassium induced contraction of smooth muscle cells in the afferent arteriole is highly sensitive to chloride.

Thus Chloride is a functional renal vasoconstrictor. Hyperchloremia has been shown to produce dose dependent renal vasoconstriction and a reduction in glomerular filtration rate.

In addition hyperchloremia may be associated with an increased risk of acute renal failure in vulnerable patients, such as those receiving radiographic contrast dye.

1. O’Malley CM, Frumento RJ, Hardy MA, et al. A randomized, double-blind comparison of lactated Ringer’s solution and 0.9% NaCl during renal transplantation. Anesth Anal 2005;100:1518–1524, table.
 
2. Hansen PB, Jensen BL, Skott O. Chloride regulates afferent arteriolar contraction in response to depolarization. Hypertension 1998;32:1066–1070.
 
3.  Hansen PB, Jensen BL, Skott O. Chloride regulates afferent arteriolar contraction in response to depolarization. Hypertension 1998;32:1066–1070.
 
4. Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest 1983; 71:726–735.