A different way to deliver intravenous fluid in hospital patients may cause fewer kidney problems and deaths, according to a new study by Intermountain Healthcare researchers.

The large-scale study, which included nearly 150,000 adult patient admitted to the emergency department or inpatient units at 22 Intermountain Healthcare hospitals in Utah and Idaho between Nov. 1, 2018, and Feb. 29, 2020, showed those who received lactated Ringer’s (LR) solution had a 2.2% reduced risk of kidney injury and death compared to the normal saline solution.

The impact was even greater in those who had sepsis, a severe infection, and those who required more fluids during their treatment.

“That might not sound like a big difference, but considering how many patients receive IV fluids every day, it could lead to a major improvement in health outcomes,” said Dr. Joseph Bledsoe, lead investigator of the study and director of research for emergency medicine for Intermountain Healthcare. “For our health system alone, that’s 3,000 people every year who may avoid complications from normal saline, at no additional cost.”

Saline solution has been the standard IV delivery method used to replenish lost fluids, clean wounds, treat dehydration, sustain patients through surgery and deliver medication. Nearly 200 million liters are given to hospital patients each year in the United States. The solution is made up of sodium chloride and water at a concentration of 0.9% of salt per liter, which are levels higher than blood, commonly called normal saline. Because saline has a higher level of chloride, it is slightly more acidic than fluids in the human body, which explains the reason for kidney problems.

Lactated Ringer’s contains electrolytes more similar to blood plasma than saline solution. It contains a mixture of sodium chloride, sodium lactate, potassium chloride and calcium chloride in water. During the study, it did not show the same risk of kidney injury that was also shown in previous, smaller studies.

The study also found that not all patients benefit from LR. Those with brain injuries may still fare better with normal saline. However, further studies are still needed, according to the research.

Researchers also found that nudges in the electronic order system at Intermountain were more effective in changing clinician habits than relying on education.

“Given the success of nudges in making the change, our success could be replicated in other health systems and allows for sustained improvement,” Bledsoe said. “Given the scope of this study and its success, in addition to previous studies, hospitals around the country should consider what they use for IV fluids too.”

Results of the study were published in the Journal of American Medicine (JAMA) Network Open.

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