{
  "abstract": "Introduction\n\nNormal 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\n\nThis 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).Results\n\nOn postoperative day 4, the RLS group maintained significantly higher serum bicarbonate (19.39 vs. 17.31 mEq/L; P < 0.001) and required substantially less rescue bicarbonate therapy (17.9% vs. 58.2%; P < 0.001) compared with the NSS + D5W group. Serum chlorides were comparable between groups on day 4. RLS was associated with more favorable early allograft function, evidenced by a higher 1-month eGFR (61.63 vs. 53.18 ml/min per 1.73 m²; P = 0.028). Among the deceased-donor recipients, a lower proportion of RLS group had high urine NGAL (>100 ng/ml) and elevated interferon-γ; however, the continuous NGAL comparison was not significant and other cytokines (tumor necrosis factor [TNF]-α, interleukin [IL]-6, and IL-10) did not differ. These exploratory biomarker findings are hypothesis-generating.Conclusion\n\nRLS effectively reduces early postoperative metabolic acidosis and was associated with better short-term allograft functional recovery compared with a chloride-reduced saline regimen. These benefits are most applicable to allografts exhibiting immediate or early function that permits standard volume expansion.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.",
    "Division of Nephrology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.",
    "Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.",
    "Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.",
    "Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.",
    "Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.",
    "Department of Microbiology, Center of Excellence on Translation Research in Inflammation and Immunology, Chulalongkorn University, Bangkok, Thailand.",
    "Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.",
    "Department of Medicine, Faculty of Medicine, Center of Excellence Renal Immunology and Renal Transplantation, Chulalongkorn University, Bangkok, Thailand."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
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        0
      ],
      "name": "Kornrawee Sawasdichai"
    },
    {
      "affs": [
        0
      ],
      "name": "Chanyanuch Rakpithayanon"
    },
    {
      "affs": [
        1
      ],
      "name": "Sirihatai Konwai"
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    {
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        0,
        2
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      "name": "Thunyatorn Wuttiputhanun"
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    {
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        0
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      "name": "Nuttha Lumlertgul"
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        3
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      "name": "Kirada Apisutimaitri"
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        3
      ],
      "name": "Rattanaporn Burimsittichai"
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        2,
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      ],
      "name": "Athaya Vorasittha"
    },
    {
      "affs": [
        4
      ],
      "name": "Pea Pobpan"
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      ],
      "name": "Adis Tasanarong"
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      ],
      "name": "Asada Leelahavanichkul"
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      ],
      "name": "Natavudh Townamchai"
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        0
      ],
      "name": "Kearkiat Praditpornsilpa"
    },
    {
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        0
      ],
      "name": "Somchai Eiam-Ong"
    },
    {
      "affs": [
        0,
        2,
        8
      ],
      "name": "Yingyos Avihingsanon"
    },
    {
      "affs": [
        0,
        2,
        8
      ],
      "name": "Suwasin Udomkarnjananun"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5v416wwb37249.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ekir.2026.107081",
  "fulltext_url": "https://europepmc.org/articles/PMC13677585",
  "id": "5v416wwb37249",
  "issns": [
    "2468-0249"
  ],
  "landing_url": "https://europepmc.org/article/MED/42898223",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2747|Renal Transplantation Outcomes and Treatments"
    ]
  ],
  "openalex": "W7213528143",
  "pdf_url": "https://europepmc.org/articles/PMC13677585?pdf=render",
  "pmcid": "PMC13677585",
  "pmid": "42898223",
  "published": "2026-09-17",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5v416wwb37249.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:41Z",
      "native_id": "MED:42898223",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42898223"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2747|Renal Transplantation Outcomes and Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation.",
  "title_text": "Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:41Z",
  "url": "https://research.draconitic.com/paper/5v416wwb37249",
  "venue": "Kidney international reports",
  "versions": []
}