The study compared the use of balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) and saline (0.9% sodium chloride) for intravenous fluid administration in critically ill adults. The primary outcome was a major adverse kidney event within 30 days, defined as death, new renal-replacement therapy, or persistent renal dysfunction. The trial involved 15,802 patients from five intensive care units (ICUs) at Vanderbilt University Medical Center. Patients were assigned to receive either balanced crystalloids or saline based on the randomization of their ICU. The results showed that the use of balanced crystalloids resulted in a lower rate of the primary outcome compared to saline (marginal odds ratio, 0.91; 95% CI, 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P = 0.04). However, there were no significant differences in in-hospital mortality, new renal-replacement therapy, or persistent renal dysfunction between the two groups. The study concluded that balanced crystalloids may be associated with better clinical outcomes in critically ill adults, particularly in patients with sepsis and those who received larger volumes of isotonic crystalloid.The study compared the use of balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A) and saline (0.9% sodium chloride) for intravenous fluid administration in critically ill adults. The primary outcome was a major adverse kidney event within 30 days, defined as death, new renal-replacement therapy, or persistent renal dysfunction. The trial involved 15,802 patients from five intensive care units (ICUs) at Vanderbilt University Medical Center. Patients were assigned to receive either balanced crystalloids or saline based on the randomization of their ICU. The results showed that the use of balanced crystalloids resulted in a lower rate of the primary outcome compared to saline (marginal odds ratio, 0.91; 95% CI, 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P = 0.04). However, there were no significant differences in in-hospital mortality, new renal-replacement therapy, or persistent renal dysfunction between the two groups. The study concluded that balanced crystalloids may be associated with better clinical outcomes in critically ill adults, particularly in patients with sepsis and those who received larger volumes of isotonic crystalloid.