Randomized Clinical Trial of Ringer's Lactate Versus Chloride-Reduced Saline-Dextrose in Postoperative Kidney Transplantation
In brief
Ringer's lactate cuts rescue bicarbonate use from 58% to 18% after transplant
In a randomized trial of 134 kidney transplant recipients, Ringer's lactate kept day-4 bicarbonate higher and reduced the share needing rescue bicarbonate from 58% to 18%, compared with chloride-reduced saline and dextrose. One-month kidney function was also better, but the findings apply most directly to grafts with early function that allows standard fluid expansion.
- Journal
- Kidney international reports (Q1)
- Published
- 17 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Kornrawee Sawasdichai, Chanyanuch Rakpithayanon, Sirihatai Konwai, Thunyatorn Wuttiputhanun, Nuttha Lumlertgul, Kirada Apisutimaitri, et al.
- PMID
- 42898223
- DOI
- 10.1016/j.ekir.2026.107081
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 21 October 2026): Randomized fluid trial measures bicarbonate and acid-base biochemistry
- Picked for Nephrology (paper of the day, 21 October 2026): Ringer's Lactate improves early allograft function
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.