BALANCED ELECTROLYTE SOLUTIONS VERSUS NORMAL SALINE FOR KIDNEY TRANSPLANTATION: AN UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS
SUSAN WAN1,2,3, KATE WYBURN1,2, STEVEN CHADBAN1,2, Michael Collins4,5,6 1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia2Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia3Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia4Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia5Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia6Australasian Kidney Trials Network, University of Queensland, Brisbane, QLD, Australia
Abstract
Aim: To compare the effects of balanced electrolyte solutions (BES) versus normal saline (NS) on the incidence of delayed graft function and hyperkalaemia in kidney transplant recipients.
Background: Peri-operative intravenous fluids are routinely administered to kidney transplant recipients to maintain blood pressure, volume status, and graft perfusion. NS is commonly used but has a high chloride content and causes hyperchloraemic metabolic acidosis, which may increase the risks of delayed graft function (DGF) and hyperkalaemia. BES have a low-chloride content, and may reduce these risks. Previous meta-analyses of randomised controlled trials (RCTs) found low-certainty evidence for the effects of BES vs NS on DGF and hyperkalaemia, but included low numbers of deceased-donor transplant recipients.
Methods: We searched MEDLINE, EMBASE and CENTRAL from inception to 28th November 2022 for RCTs of kidney transplant recipients comparing peri-operative BES to NS. Two independent reviewers assessed studies for eligibility and risk of bias.
Results: Ten studies (1532 participants) were included. The overall risk of bias varied from low to high. The relative risk (RR) of DGF with BES vs NS was 0.82 (95%CI 0.71-0.94; p=0.005; seven studies, n=1306) with low heterogeneity (Chi2=5.06, df=6, p=0.54, I2=0%). This was driven by four studies (n=1105) in deceased-donor recipients (RR 0.83; 95%CI 0.71–0.96; p=0.01); there was no difference in DGF risk in three studies (n=201) in living-donor recipients (RR 0.79; 95%CI 0.26–2.41; p=0.68). There was no difference in the risk of hyperkalaemia with BES vs NS (RR 0.87; 95%CI 0.59–1.27; p=0.46; four studies, 1055 participants).
Conclusions: Compared with NS, peri-operative fluid therapy with BES reduces DGF risk, particularly in deceased-donor kidney transplant recipients, but does not affect the risk of hyperkalaemia.
Biography
Dr Michael Collins MBChB FRACP PhD is a transplant nephrologist who trained in Auckland, New Zealand, and is now working at the Royal Adelaide Hospital in Australia. He completed a PhD in transplant immunology (University of Adelaide) before developing an interest in clinical trials. His research focuses on trials to improve outcomes for patients receiving a kidney transplant, and he is the co-lead investigator of the BEST-Fluids trial, a multi-centre randomised trial of IV fluid therapy in kidney transplantation to prevent delayed graft function. He is a previous Jacquot Research Establishment Fellowship recipient. He is currently the Deputy Chair (Scientific Committee) and Executive member of the Australasian Kidney Trials Network.