Tanaka Yu, Horinouchi Tomoko, Inoki Yuta, Ichikawa Yuta, Ueda Chika, Kitakado Hideaki, Kondo Atsushi, Sakakibara Nana, Ishimori Shingo, Yamamura Tomohiko, Nagano China, Nozu Kandai
Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Pediatr Nephrol. 2025 Apr;40(4):1033-1040. doi: 10.1007/s00467-024-06594-0. Epub 2024 Nov 25.
Isotonic fluids are becoming the standard for hydration and maintenance fluid therapy, but there is no consensus on the optional choice among the different types of isotonic solution.
This study is a single-center, non-randomized controlled trial at Kobe University Hospital, Japan, between April 2021 and March 2023. The study included pediatric patients aged 1-19 years who underwent kidney biopsies. From April 2021 to March 2022, 0.9% sodium chloride (saline) was administered, and from April 2022 to March 2023, balanced crystalloids were used. The primary outcome was the occurrence of hyponatremia (< 137 mEq/L) after a kidney biopsy. Secondary outcomes included other electrolyte balances, blood gas parameters, creatinine-based estimated glomerular filtration rate (Cr-eGFR), and arginine vasopressin concentrations (UMIN Clinical Trial Registry: UMIN 000044330).
Of 61 patients enrolled, 2 were excluded, leaving 34 in the saline group and 25 in the balanced crystalloid group. No hyponatremia occurred, and serum sodium concentrations were similar between both groups (138.7 vs. 138.9 mEq/L, P = 0.08). The saline group showed a greater increase in serum chloride (+ 1.7 vs. + 0.2, P < 0.01) and a greater decrease in HCO concentrations (- 0.6 vs. + 0.9, P < 0.01). There were minimal changes in pH (- 0.01 vs. - 0.01, P = 0.99) and Cr-eGFR (- 1.5 vs. + 1.1 mL/min/1.73 m, P = 0.96) in both groups.
During pediatric kidney biopsy, both saline and balanced crystalloids were effective in preventing hyponatremia. Although saline infusion results in higher serum chloride concentrations and lower blood HCO concentrations than balanced crystalloids infusion, the clinical significance was minimal.
等渗液正成为补液和维持液体治疗的标准，但对于不同类型等渗溶液的最佳选择尚无共识。
本研究是一项于2021年4月至2023年3月在日本神户大学医院进行的单中心、非随机对照试验。该研究纳入了1至19岁接受肾活检的儿科患者。2021年4月至2022年3月，给予0.9%氯化钠（生理盐水），2022年4月至2023年3月，使用平衡晶体液。主要结局是肾活检后低钠血症（<137 mEq/L）的发生情况。次要结局包括其他电解质平衡、血气参数、基于肌酐的估计肾小球滤过率（Cr-eGFR）和精氨酸加压素浓度（UMIN临床试验注册中心：UMIN 000044330）。
在纳入的61例患者中，排除2例，生理盐水组34例，平衡晶体液组25例。未发生低钠血症，两组血清钠浓度相似（138.7对138.9 mEq/L，P = 0.08）。生理盐水组血清氯升高幅度更大（+1.7对+0.2，P < 0.01），HCO浓度降低幅度更大（-0.6对+0.9，P < 0.01）。两组pH（-0.01对-0.01，P = 0.99）和Cr-eGFR（-1.5对+1.1 mL/min/1.73 m，P = 0.96）变化极小。
在儿科肾活检期间，生理盐水和平衡晶体液在预防低钠血症方面均有效。尽管输注生理盐水比输注平衡晶体液导致更高的血清氯浓度和更低的血液HCO浓度，但临床意义极小。
