Wan Susan S, Wyburn Kate, Chadban Steven J, Collins Michael G
Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
Transplant Direct. 2024 Dec 13;11(1):e1687. doi: 10.1097/TXD.0000000000001687. eCollection 2025 Jan.
Perioperative intravenous fluids are administered to kidney transplant recipients to maintain hemodynamic stability and graft perfusion; however, the ideal fluid remains uncertain. Although 0.9% saline (saline) is commonly used, its high chloride content causes hyperchloremic metabolic acidosis and may increase the risks of delayed graft function (DGF) and hyperkalemia. Balanced electrolyte solutions (BES) have a more physiological chloride concentration and may reduce these risks. Previous meta-analyses found insufficient evidence to compare BES with saline for these outcomes; however, new studies have recently been published. In this updated review, we compared the effects of BES with saline on the risk of DGF and hyperkalemia in kidney transplantation.
MEDLINE, Embase, and CENTRAL were searched for randomized controlled trials comparing BES with saline in kidney transplantation. The primary outcomes were DGF and hyperkalemia. Eligible studies were assessed for risk of bias and data were pooled for analysis. The Grading of Recommendations Assessment, Development, and Evaluation framework was used to assess the quality of evidence.
Ten studies involving 1532 participants were included. The quality of evidence was high for deceased donor transplantation and very low for living donor transplantation. The relative risk (RR) of DGF associated with BES compared with saline was 0.83 (95% confidence interval [CI], 0.71-0.96; = 0.01) in deceased donor transplantation. There was no difference in DGF in living donor transplantation (RR 0.79; 95% CI, 0.26-2.41; = 0.68). There was no difference in hyperkalemia between groups (RR 0.87; 95% CI, 0.59-1.27; = 0.46).
Compared with saline, BES reduces the risk of DGF in deceased donor kidney transplantation without increasing hyperkalemia.
围手术期静脉输液用于肾移植受者以维持血流动力学稳定和移植肾灌注；然而，理想的液体仍不确定。尽管常用0.9%氯化钠溶液（生理盐水），但其高氯含量会导致高氯性代谢性酸中毒，并可能增加移植肾功能延迟恢复（DGF）和高钾血症的风险。平衡电解质溶液（BES）具有更符合生理的氯浓度，可能会降低这些风险。以往的荟萃分析发现，尚无足够证据比较BES与生理盐水在这些结局方面的差异；然而，最近有新的研究发表。在这项更新的综述中，我们比较了BES与生理盐水对肾移植中DGF风险和高钾血症的影响。
检索MEDLINE、Embase和CENTRAL数据库，查找比较BES与生理盐水在肾移植中的随机对照试验。主要结局为DGF和高钾血症。对符合条件的研究进行偏倚风险评估，并汇总数据进行分析。采用推荐分级评估、制定和评价框架来评估证据质量。
纳入了10项研究，共1532名参与者。在 deceased donor 移植中证据质量高，在 living donor 移植中证据质量非常低。在 deceased donor 移植中，与生理盐水相比，BES相关的DGF相对风险（RR）为0.83（95%置信区间[CI]，0.71 - 0.96；P = 0.01）。在 living donor 移植中，DGF无差异（RR 0.79；95% CI，0.26 - 2.41；P = 0.68）。两组之间高钾血症无差异（RR 0.87；95% CI，0.59 - 1.27；P = 0.46）。
与生理盐水相比，BES可降低 deceased donor 肾移植中DGF的风险，且不增加高钾血症风险。
