Kidney international reports
Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation
Par Sawasdichai K, Rakpithayanon C, Konwai S et 13 autres.
Contenu en anglais
Résumé
Introduction
Normal saline administration induces hyperchloremic metabolic acidosis, potentially impairing kidney allograft recovery. The comparative efficacy of balanced crystalloids against actively chloride-reduced saline protocols remains unclear.
Methods
This randomized, open-label trial compared Ringer's Lactate Solution (RLS) with a dynamic dual-infusion protocol of normal saline and 5% dextrose (NSS + D5W) in adult kidney transplant recipients. Using a prespecified modified intention-to-treat analysis, 134 patients who received ≥2 L of study fluid were evaluated. Fluids were strictly titrated to hourly urine output. The primary outcome was day-4 serum bicarbonate. Secondary outcomes evaluated the overall treatment strategy, including protocolized rescue bicarbonate requirements, 1-month estimated glomerular filtration rate (eGFR) as an indicator of early functional recovery, and exploratory mechanistic biomarkers (urine neutrophil gelatinase-associated lipocalin [NGAL] and serum cytokines).