Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA.
Saint Louis University, School of Medicine, Division of Nephrology, St. Louis, MO, USA.
Transplant Rev (Orlando). 2024 Dec;38(4):100876. doi: 10.1016/j.trre.2024.100876. Epub 2024 Aug 8.
Although kidney transplantation (KT) is the best treatment option for end-stage kidney disease, long-term complications such as chronic kidney allograft dysfunction and cardiovascular disorders are observed. To decrease these complications, preventive measures must be applied in kidney transplant recipients (KTRs). One of these common measures is the increase of water/fluid intake although this is not evidence-based practice. Indeed, surprisingly very limited studies evaluated the impact of increased water/fluid intake on graft function, with small number of KTRs and short term follow-up. We suggest that the water/fluid intake should be personalized based on baseline graft function, time onset after KT (which water homeostasis changes), presence of hyponatremia and hypervolemia, concomitant medications, and patient willingness. Methods for estimating water/fluid intake (direct measurement, 24-h urine volume measurement, urine osmolarity) has both advantages and drawbacks and the best method has not been identified. Increase of water/fluid intake in specific conditions (in hot, and humid weather, before exercise, during Ramadan fasting) or in distinct KTRs (KTRs with de novo nephrolithiasis, frequent urinary tract infections) is not tested. Furthermore, the relationship between water/fluid intake and major cardiovascular adverse events are not known. There is no doubt that minimum amount of water/fluid intake is necessary for graft function (the amount is not known) but there is no evidence for a particular target level of water/fluid intake. In the current review, we summarize the studies assessing fluid/water intake in KTR, explained the pathophysiologic basis of water disorders in early period of KT and late after KT, elucidate conflicts and unknown issues of water intake in KTRs and suggest future research needs.
尽管肾移植（KT）是治疗终末期肾病的最佳选择，但仍会出现慢性肾移植功能障碍和心血管疾病等长期并发症。为了减少这些并发症，必须在肾移植受者（KTR）中采取预防措施。其中一种常见措施是增加水/液体摄入，尽管这不是基于证据的实践。事实上，令人惊讶的是，只有极少数研究评估了增加水/液体摄入对移植物功能的影响，而且这些研究的 KTR 数量较少，随访时间较短。我们建议根据基线移植物功能、KT 后时间（水动态平衡变化）、低钠血症和高血容量的存在、伴随的药物和患者意愿来个性化水/液体摄入。估计水/液体摄入的方法（直接测量、24 小时尿液量测量、尿渗透压）各有优缺点，尚未确定最佳方法。在特定情况下（在炎热、潮湿的天气、运动前、斋月禁食期间）或在特定 KTR 中（新发肾结石、频繁尿路感染的 KTR）增加水/液体摄入并未得到测试。此外，水/液体摄入与主要心血管不良事件之间的关系尚不清楚。毫无疑问，KTR 移植物功能需要最低量的水/液体摄入（摄入量未知），但没有证据表明水/液体摄入有特定的目标水平。在当前的综述中，我们总结了评估 KTR 液体/水摄入的研究，解释了 KT 早期和 KT 后期水紊乱的病理生理基础，阐明了 KTR 水摄入的冲突和未知问题，并提出了未来的研究需求。
