***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units ( ICUs ) affects survival . We conducted a multicenter , r and omized , double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU . METHODS We r and omly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days . The primary outcome measure was death from any cause during the 28-day period after r and omization . RESULTS Of the 6997 patients who underwent r and omization , 3497 were assigned to receive albumin and 3500 to receive saline ;  the two groups had similar baseline characteristics . There were 726 deaths in the albumin group , as compared with 729 deaths in the saline group ( relative risk of death , 0.99 ; 95 percent confidence interval , 0.91 to 1.09 ; P=0.87 ) . The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups ( P=0.85 ) . There were no significant differences between the groups in the mean ( + /-SD ) numbers of days spent in the ICU ( 6.5+/-6.6 in the albumin group and 6.2+/-6.2 in the saline group , P=0.44 ) , days spent in the hospital ( 15.3+/-9.6 and 15.6+/-9.6 , respectively ; P=0.30 ) , days of mechanical ventilation ( 4.5+/-6.1 and 4.3+/-5.7 , respectively ; P=0.74 ) , or days of renal-replacement therapy ( 0.5+/-2.3 and 0.4+/-2.0 , respectively ; P=0.41 ) . CONCLUSIONS In patients in the ICU , use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days Background Pneumoperitoneum ( PP ) , as used for laparoscopic procedures , impairs stroke volume , renal blood flow , glomerular filtration rate and urine output . This study investigated whether perioperative fluid management can abolish these negative effects of PP on hemodynamics . Methods Twenty-one patients undergoing laparoscopic donor nephrectomy ( LDN ) were r and omized into three groups : group 1 received overnight infusion and received a bolus of colloid before induction of anesthesia , followed by a bolus just before PP ; group 2 received overnight infusion and a colloid bolus before anesthesia ; group 3 served as controls and received only infusion during operation . All three groups received the same total amount of crystalloids and colloids until nephrectomy . Data analysis of the donor included ; mean arterial pressure ( MAP ) , stroke volume ( SV ) , left ventricular ejection time ( LVETc ) , perioperative urine output and renal function measured as the creatinine clearance ( CrCl ) until one-year post-operative . Results SV was significantly higher in group 1 compared to controls for all measurements . In the control group SV significantly decreased after changing from the supine to lateral position whereas there was no change in SV in both pre-hydrated groups . In all groups , MAP decreased after induction of anesthesia , and restored to pre-anesthetic values during PP . CrCl decreased in the control group during PP , but not in the other groups . From two days postoperative , CrCl was comparable between the three study groups . Conclusion Overnight infusion and a bolus of colloid just before PP attenuate hemodynamic compromise from PP BACKGROUND : Early graft function is crucial for successful kidney transplantation . Maintaining adequate hydration is complicated by rapid movement of water to the extravascular space . We design ed this study to test the effect of maximal hydration during graft ischemia time on early renal function . METHODS : Forty adult patients with chronic renal failure underwent renal transplantation from related living donors . Study subjects were r and omly assigned 1 of 2 regimens for intraoperative hydration . The constant infusion rate group received normal saline 0.9 % at an infusion rate 10 to 12 mL · kg−1 · h−1 from the start of surgery until the renal vessels were unclamped after vascular anastomosis . The central venous pressure target ( CVPT ) group received normal saline 0.9 % titrated to maintain a specific central venous pressure ( CVP ) . The target CVP from the start of surgery until clamping of the donor renal vessels was 5 mm Hg except for the interval from clamping of the renal vessels until the end of renal vascular anastomosis , when the target CVP was 15 mm Hg . Perioperative hemodynamics , infused saline volumes , rate of infusion , onset of diuresis , graft turgidity , urine volume , and renal function during the first 5 postoperative days were recorded . RESULTS : At the end of renal ischemia time , both groups had received approximately 3 L crystalloid solution . The CVPT group achieved the highest peak of intravascular volume expansion with an average infusion rate of 48.3 mL · min−1 during 48 ± 12 minutes of renal ischemia . The CVPT group had better graft function , required fewer vasopressors and diuretics , and had less postoperative tissue edema than the constant infusion rate group . CONCLUSIONS : Hydration directed toward maintaining a given CVP during kidney transplantation produced a more stable hemodynamic profile and promoted diuresis . The calculated infusion rate of approximately 45 to 50 mL · min−1 , within an hour ischemia time , seems feasible to enhance early graft function . A larger trial with long-term follow-up of renal function is warranted to confirm the clinical benefit of titrating IV crystalloid administration to maintain a given CVP in this population CONTEXT Administration of traditional chloride-liberal intravenous fluids may precipitate acute kidney injury ( AKI ) . OBJECTIVE To assess the association of a chloride-restrictive ( vs chloride-liberal ) intravenous fluid strategy with AKI in critically ill patients . DESIGN , SETTING , AND PATIENTS Prospect i ve , open-label , sequential period pilot study of 760 patients admitted consecutively to the intensive care unit ( ICU ) during the control period ( February 18 to August 17 , 2008 ) compared with 773 patients admitted consecutively during the intervention period ( February 18 to August 17 , 2009 ) at a university-affiliated hospital in Melbourne , Australia . INTERVENTIONS During the control period , patients received st and ard intravenous fluids . After a 6-month phase-out period ( August 18 , 2008 , to February 17 , 2009 ) , any use of chloride-rich intravenous fluids ( 0.9 % saline , 4 % succinylated gelatin solution , or 4 % albumin solution ) was restricted to attending specialist approval only during the intervention period ; patients instead received a lactated solution ( Hartmann solution ) , a balanced solution ( Plasma-Lyte 148 ) , and chloride-poor 20 % albumin . MAIN OUTCOME MEASURES The primary outcomes included increase from baseline to peak creatinine level in the ICU and incidence of AKI according to the risk , injury , failure , loss , end-stage ( RIFLE ) classification . Secondary post hoc analysis outcomes included the need for renal replacement therapy ( RRT ) , length of stay in ICU and hospital , and survival .  RESULTS Chloride administration decreased by 144 504 mmol ( from 694 to 496 mmol/patient ) from the control period to the intervention period . Comparing the control period with the intervention period , the mean serum creatinine level increase while in the ICU was 22.6 μmol/L ( 95 % CI , 17.5 - 27.7 μmol/L ) vs 14.8 μmol/L ( 95 % CI , 9.8 - 19.9 μmol/L ) ( P = .03 ) , the incidence of injury and failure class of RIFLE-defined AKI was 14 % ( 95 % CI , 11%-16 % ; n = 105 ) vs 8.4 % ( 95 % CI , 6.4%-10 % ; n = 65 ) ( P < .001 ) , and the use of RRT was 10 % ( 95 % CI , 8.1%-12 % ; n = 78 ) vs 6.3 % ( 95 % CI , 4.6%-8.1 % ; n = 49 ) ( P = .005 ) . After adjustment for covariates , this association remained for incidence of injury and failure class of RIFLE-defined AKI ( odds ratio , 0.52 [ 95 % CI , 0.37 - 0.75 ] ; P < .001 ) and use of RRT ( odds ratio , 0.52 [ 95 % CI , 0.33 - 0.81 ] ; P = .004 ) . There were no differences in hospital mortality , hospital or ICU length of stay , or need for RRT after hospital discharge . CONCLUSION The implementation of a chloride-restrictive strategy in a tertiary ICU was associated with a significant decrease in the incidence of AKI and use of RRT . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT00885404 Normal saline ( NS ; 0.9 % NaCl ) is administered during kidney transplantation to avoid the risk of hyperkalemia associated with potassium-containing fluids . Recent evidence suggests that NS may be associated with adverse effects that are not seen with balanced-salt fluids , e.g. , lactated Ringer ’s solution ( LR ) . We hypothesized that NS is detrimental to renal function in kidney transplant recipients . Adults undergoing kidney transplantation were enrolled in a prospect i ve , r and omized , double-blind clinical trial of NS versus LR for intraoperative IV fluid therapy . The primary outcome measure was creatinine concentration on postoperative Day 3 . The study was terminated for safety reasons after interim analysis of data from 51 patients . Forty-eight patients underwent living donor kidney transplants , and three patients underwent cadaveric donor transplants . Twenty-six patients received  NS , and 25 patients received LR . There was no difference between groups in the primary outcome measure . Five ( 19 % ) patients in the NS group versus zero ( 0 % ) patients in the LR group had potassium concentrations > 6 mEq/L and were treated for hyperkalemia ( P = 0.05 ) . Eight ( 31 % ) patients in the NS group versus zero ( 0 % ) patients in the LR group were treated for metabolic acidosis ( P = 0.004 ) . NS did not adversely affect renal function .  LR was associated with less hyperkalemia and acidosis compared with NS . LR may be a safe choice for IV fluid therapy in patients undergoing kidney transplantation BACKGROUND Hydroxyethylstarch used as a plasma-volume exp and er in brain-dead kidney donors has been suggested to induce osmotic-nephrosis-like lesions . We have studied its effect on kidney-transplant function . METHODS 52 patients who had received hydroxyethylstarch of iodinated contrast-media before brain death were excluded . 69 other brain-dead patients were prospect ively included over 18 months and r and omised into two groups . In the hydroxyethylstarch-gelatin group , patients received hydroxyethylstarch up to 33 mL/kg for colloid plasma-volume expansion , and afterwards received modified fluid gelatin . In the gelatin-only group , patients received only modified fluid gelatin as colloid plasma-volume exp and er . Multiple organs were procured in 29 cases , which included the kidneys in 27 cases ( hydroxyethylstarch-gelatin 15 , gelatin-only 12 ) . FINDINGS There were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients ( except for a small imbalance in sex in the recipients ) . During the first 8 days after transplantation , nine of 27 ( 33 % ) patients required extrarenal haemodialysis or haemodiafiltration in the hydroxyethylstarch-gelatin group compared with one of 20 ( 5 % ) in the gelatin-only group ( p = 0.029 ) . Serum creatinine concentrations were significantly lower in the gelatin-only group than in the other group ( p = 0.009 ) . 10 days after transplantation , mean ( SD ) serum creatinine was , respectively , 145 ( 70 ) and 312 ( 259 ) mumol/L. INTERPRETATION These data suggest that hydroxyethylstarch used as a plasma-volume exp and er in brain-dead donors impairs immediate renal function in kidney-transplant recipients Aim . We hypothesized that normal saline ( NS ) may have more deleterious effects compared with lactated ringer ( LR ) in kidney transplant recipients because of the higher risk of acidosis and higher levels of serum potassium . Thus , the aim of this study was to determine the safety of LR if used during a renal transplant . Methods . Adults undergoing kidney transplantations were enrolled in a double-blinded r and omized prospect i ve clinical trial . They were divided into two groups in order 
    Output:
    
Balanced electrolyte solutions are associated with less hyperchloraemic metabolic acidosis compared to normal saline , however it remains uncertain whether lower-chloride solutions lead to improved graft outcomes compared to normal saline