SMART
Isotonic Solutions and Major Adverse Renal Events Trial
Patient / Population Intervention / Exposure Comparison Outcome
In 15,802 ICU patients, balanced crystalloids reduced the composite of major adverse kidney events at 30 days versus saline.
N
15,802
Design
Cluster-randomised crossover trial, Vanderbilt
Endpoint
MAKE30 (death, RRT or persistent renal dysfunction)
Relevance
2
Result14.3% vs 15.4% (OR 0.91; p=0.04).
Semler MW, et al. N Engl J Med. 2018;378(9):829-839. 10.1056/NEJMoa1711584
Discussion & critique
Small absolute effect but a defensible default for balanced solutions in non-TBI ICU patients.