CAIRAN UNTUK GANGGUAN GINJAL

Saline normal (0,9% NaCl) sedikit hipertonik dibandingkan dengan plasma dan memiliki pH
asam 5,6 (4.5–7.0). Akibatnya, administrasi volume besar garam normal telah dikaitkan
dengan acidosis metabolik hiperkloremik, vasokonstriksi ginjal dan peningkatan sensitivitas
terhadap aldosteron, yang keduanya menyebabkan penurunan tingkat filtrasi glomerular
yang diperkirakan (eGFR), sekresi cytokine pro-inflamasi, dan gangguan jalur koagulasi
fisiologis.

Normal saline (0.9% NaCl; i.e. 154 mmol/L Na and 154 mmol/L Cl, osmolarity 308 mOsm/L) is
the most prescribed IV fluid therapy, with more than 200 million liters per year prescribed in
the USA alone [2]. However, it is slightly hypertonic compared with plasma and has an acidic pH
of 5.6 (4.5–7.0). As a consequence, administration of a large volume of normal saline has been
linked to hyperchloremic metabolic acidosis, renal vasoconstriction and increased sensitivity to
aldosterone ]both of which lead to decline in estimated glomerular filtration rate (eGFR)],
secretion of pro-inflammatory cytokines, and disruption of physiological coagulation pathways
[3–5]. In healthy subjects, renal artery blood flow velocity and renal cortical tissue perfusion
decreased following the administration of 2 L of normal saline but not following balanced
crystalloids such as Plasma-Lyte 148, as evidenced by the association between plasma chlorine
levels and mean renal artery flow velocity or renal cortical tissue perfusion [6, 7].

Ringer's lactate has been linked to hyperglycemia through the conversion of lactate into glucose
via gluconeogenesis, lactic acidosis in patients with chronic liver disease secondary to its
inability to convert lactate into bicarbonate, cerebral edema for its hypotonic nature, and
chelation of calcium with citrate when administered with blood products and certain antibiotics
such as ceftriaxone [2, 3, 8]. Similar chelation considerations should be considered in all
solutions containing calcium, including Hartmann's solution [2, 3, 8]. Additionally, acetate-
containing solutions have a potential to suppress myocardial contractility and cause
hypotension, especially in patients undergoing renal replacement therapy; nevertheless, they
undergo extrahepatic conversion and are therefore safe in patients with chronic liver disease
[2, 3, 8].

Another important consideration in crystalloid fluid choice is the potassium content, especially
in hyperkalemic patients or patients with acute kidney injury (AKI) or chronic kidney disease
(CKD). However, studies have demonstrated no benefit of normal saline over balanced
crystalloid solutions containing potassium, which may be attributable to the potential acidosis-
mediated hyperkalemia observed in the normal saline group [9]. In this regard, acidosis
promotes exit of intracellular potassium to the extracellular space.

Glucose or dextrose (usually 5%–10%) solutions are sodium-free and do not contribute to
hypervolemia. They contain a small number of calories (200 to 400 kcal/L for glucose and 170–
340 kcal/L for dextrose) and in the presence of a conserved insulin response, will promote
potassium entry into cells. However, they facilitate hyponatremia in patients with deficient
water excretion mechanisms and may contain 3,4-dideoxyglucosone-3-ene (3,4-DGE), a
glucose-degradation product which is cytotoxic to leukocytes and kidney cells [10–14].

Colloid fluids have now been rarely utilized in clinical practice including the care for critically ill
patients, while the most commonly utilized colloid solutions include gelatin, dextrane, albumin
and hydroxyethyl starch (HES). The use of semisynthetic colloid solutions has been associated