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Balanced Electrolyte Solutions Versus 0.9% Saline for Kidney Transplantation: An Updated Systematic Review and
Susan S Wan1,2,3, Kate Wyburn1,2, Steven J Chadban1,2
1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Transplantation Direct
|December 17, 2024
Summary
Balanced electrolyte solutions (BES) reduce the risk of delayed graft function (DGF) in deceased donor kidney transplants compared to saline. This study found no increased risk of hyperkalemia with BES, offering a potentially safer fluid choice for kidney transplant recipients.
Area of Science:
- Nephrology and Transplant Surgery
- Critical Care Medicine
- Pharmacology and Therapeutics
Background:
- Perioperative intravenous fluids are crucial for hemodynamic stability and graft perfusion in kidney transplant recipients.
- 0.9% saline, a common choice, may elevate risks of delayed graft function (DGF) and hyperkalemia due to its high chloride content.
- Balanced electrolyte solutions (BES) offer a more physiological alternative, prompting investigation into their comparative efficacy.
Purpose of the Study:
- To compare the effects of balanced electrolyte solutions (BES) versus 0.9% saline on the risk of DGF and hyperkalemia in kidney transplant recipients.
- To update previous meta-analyses with recently published randomized controlled trials (RCTs).
Main Methods:
- Systematic literature search of MEDLINE, Embase, and CENTRAL for RCTs comparing BES with saline in kidney transplantation.
- Primary outcomes assessed were DGF and hyperkalemia.
- Risk of bias assessment and data pooling were performed; evidence quality was evaluated using the GRADE framework.
Main Results:
- Ten studies with 1532 participants were included; evidence quality was high for deceased donor and very low for living donor transplantation.
- BES significantly reduced the risk of DGF in deceased donor kidney transplantation (RR 0.83; 95% CI, 0.71-0.96; P=0.01).
- No significant differences in DGF for living donor transplantation or hyperkalemia between BES and saline groups were observed.
Conclusions:
- Balanced electrolyte solutions (BES) are associated with a reduced risk of delayed graft function (DGF) in deceased donor kidney transplantation when compared to saline.
- The use of BES did not increase the risk of hyperkalemia in kidney transplant recipients.
- BES represent a potentially favorable fluid management strategy in perioperative care for deceased donor kidney transplantation.
