Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation.
9 affiliations
- 1Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- 2Division of Nephrology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand.
- 3Excellence Center for Solid Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
- 4Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- 5Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- 6Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
- 7Department of Microbiology, Center of Excellence on Translation Research in Inflammation and Immunology, Chulalongkorn University, Bangkok, Thailand.
- 8Department of Microbiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- 9Department of Medicine, Faculty of Medicine, Center of Excellence Renal Immunology and Renal Transplantation, Chulalongkorn University, Bangkok, Thailand.
Abstract
Introduction
Normal 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
This 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
On 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
RLS 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.
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BibTeX
@article{sawasdichai2026randomized,
title = {{Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation.}},
author = {Kornrawee Sawasdichai and Chanyanuch Rakpithayanon and Sirihatai Konwai and Thunyatorn Wuttiputhanun and Nuttha Lumlertgul and Kirada Apisutimaitri and Rattanaporn Burimsittichai and Athaya Vorasittha and Pea Pobpan and Adis Tasanarong and Asada Leelahavanichkul and Natavudh Townamchai and Kearkiat Praditpornsilpa and Somchai Eiam-Ong and Yingyos Avihingsanon and Suwasin Udomkarnjananun},
journal = {Kidney international reports},
year = {2026},
month = sep,
doi = {10.1016/j.ekir.2026.107081},
url = {https://europepmc.org/article/MED/42898223},
note = {CC BY},
}
RIS
TY - JOUR
TI - Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation.
AU - Kornrawee Sawasdichai
AU - Chanyanuch Rakpithayanon
AU - Sirihatai Konwai
AU - Thunyatorn Wuttiputhanun
AU - Nuttha Lumlertgul
AU - Kirada Apisutimaitri
AU - Rattanaporn Burimsittichai
AU - Athaya Vorasittha
AU - Pea Pobpan
AU - Adis Tasanarong
AU - Asada Leelahavanichkul
AU - Natavudh Townamchai
AU - Kearkiat Praditpornsilpa
AU - Somchai Eiam-Ong
AU - Yingyos Avihingsanon
AU - Suwasin Udomkarnjananun
PY - 2026
DA - 2026/09/17
JO - Kidney international reports
DO - 10.1016/j.ekir.2026.107081
UR - https://europepmc.org/article/MED/42898223
AB - Introduction Normal 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 This 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 On 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 RLS 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.
SN - 2468-0249
ER -