Lactated Ringer's vs. normal saline solution for renal transplantation: Systematic review and meta-analysis
Keywords:
Kidney transplantation, Acidosis, Hyperkalemia, Sodium chloride, Perioperative Period
Abstract
Background: The administration of potassium solutions may result in hyperpotassemia during surgery; normal saline solution (NSS) traditionally used in renal transplant may cause hyperchloremic acidosis.
Objective: To compare the safety of Lactated Ringer's (LR) against NSS in renal transplantation.
Search strategy: A systematic review was completed on Central Cochrane Registry - controlled trials, Medline, Lilacs, EBSCO and Embase, accessing review articles and contacting expert clinicians. There was no language restriction.
Selection criteria: Randomized controlled trials on adult patients undergoing renal transplantation.
Data collection and analysis: Independent trial selection, quality assessment and data extraction were performed. The mean differentials were estimated with a 95% confidence interval (95% CI). Heterogeneity was evaluated with statistic I-square(I2) and the fixed and random effect models were used.
Results: Four trials with a total of 237 patients were included. At the end of surgery, the potassium differential was non-significant (means difference (MD: -0.26 mEq/L; CI 95%: -0.58 to 0.05 p = 0.10; I2 = 75%); the pH was lower in the NSS group (MD: 0.06; CI 95%: 0.05-0.08; p < 0.001; I2 = 17%). No difference in Creatinine was identified on the third postoperative day (MD: -0.05; CI 95%: -0.59 to 0.48; p = 0.85; I2 = 0%).
Condusions: The use of RL vs. NSS during the renal transplantation perioperative period results in lower potassium and chloride levels and a higher pH, with no significant Creatinine changes.
References
1. O'Malley CM, Frumento RJ, Bennett-Guerrero E. Intravenous fluid therapy in renal transplant recipients: results of a US survey. Transplant Proc. 2002;34:3142-5.
2. O'Malley CM, Frumento RJ, Hardy MA, Benvenisty AI, Brentjens TE, Mercer JS, et al. A randomized, double-blind comparison of Lactated Ringer's solution and 0.9% NaCl during renal transplantation. Anesth Analg. 2005;100:1518-24.
3. Khajavi MR, Etezadi F, Moharari RS, Imani F, Meysamie AP, Khashayar P, et al. Effects of normal saline vs. Lactated Ringer's during renal transplantation. Ren Fail. 2008;30:535-9.
4. Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology. 1999;90:1265-70.
5. Prough DS, Bidani A. Hyperchloremic metabolic acidosis is a predictable consequence of intraoperative infusion of 0.9% saline. Anesthesiology. 1999;90:1247-9.
6. Yunos NM, Bellomo R, Story D, Kellum J. Bench-to-bedside review: chloride in critical illness. Crit Care. 2010;14:226.
7. Kaufman D, Kitching AJ, Kellum JA. Acid-base balance. In: Principles of critical care. 3rd edition New York: Gregory & Hall, McGraw-Hill; 2005. p. 1201-8.
8. Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous Lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999;88:999-1003.
9. Meier-Kriesche HU, Port FK, Ojo AO, Rudich SM, Hanson JA, Cibrik DM, et al. Effect of waiting time on renal transplant outcome. Kidney Int. 2000;58:1311-7.
10. Lemmens HJ. Kidney transplantation: recent developments and recommendations for anesthetic management. Anesthesiol Clin North Am. 2004;22:651-62.
11. Hadimioglu N, Saadawy I, Saglam T, Ertug Z, Dinckan A. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesth Analg. 2008;107:264-9.
12. Modi MP, Vora KS, Parikh GP, Shah VR. A comparative study of impact of infusion of Ringer's Lactate solution versus normal saline on acid-base balance and serum electrolytes during live related renal transplantation. Saudi J Kidney Dis Transpl. 2012;23:135-7.
13. Nuraei N, Khajenouri R, Soleimani M, Dabbagh A. The effects of intraoperative normal saline versus Lactated Ringer solution on clinical outcomes and laboratory findings in renal transplant patients. Tehran Univ Med J. 2010;68:872-7.
14. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane collaboration 2011. [Citado 06.02.14]. Available from: http://handbook.cochrane.org/
15. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725-30.
16. Rabbat CG, Thorpe KE, Russell JD, Churchill DN. Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol. 2000;11:917-22.
17. Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001;12:589-97.
18. Brunkhorst R, Lufft V, Dannenberg B, Kliem V, Tusch G, Pichlmayr R. Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study. Transplantation. 2003;76:115-9.
19. U.S. Renal Data System. USRDS 2013 annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; 2013. [Citado 06.02.14]. Available from: http://www.usrds.org/adr.aspx
20. Locatelli F, Bommer J, London GM, Martín-Malo A, Wanner C, Yaqoob M, et al. Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant. 2001;16:459-68.
21. Arici M, Walls J. End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int. 2001;59:407-14.
22. Lagrand WK, Visser CA, Hermens WT, Niessen HW, Verheugt FW, Wolbink GJ, et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation. 1999;100:96-102.
23. Yigla M, Nakhoul F, Sabag A, Tov N, Gorevich B, Abassi Z, et al. Pulmonary hypertension in patients with end-stage renal disease. Chest. 2003;123:1577-82.
24. Rivera D, Tejada JH, Medina A, Martinez E, Nieto N. Anesthesia complications in renal transplantation. Rev Colomb Anestesiol. 2011;39:30-7.
25. Social MdP. Informe de pacientes trasplantados por departamento y EPS en Colombia; 2008-2010. [Citado 06.02.14]. Available from: http://www.cuentadealtocosto.org/byblos/Docs/Informe_de-trasplante_renal_enXolombia_segun_Departamento_2011.pdf
26. Cubillos J, Sandoval CL, Andrade E, Hermida NH. Causas que contribuyen a la pérdida del trasplante renal de donante cadaverico en la fundación Surcolombiana de Trasplantes. Febrero 2007 a noviembre 2012, Neiva, Colombia. Rev Colomb Anestesiol. 2014;42:83-9.
27. Hirata ES, Baghin MF, Pereira RI, Alves Filho G, Udelsmann A. Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study. Rev Bras Anestesiol. 2009;59:166-76.
28. Bhosale G, Shah V. Combined spinal-epidural anesthesia for renal transplantation. Transplant Proc. 2008;40:1122-1.
29. Humar A, Kerr SR, Ramcharan T, Gillingham KJ, Matas AJ. Peri-operative cardiac morbidity in kidney transplant recipients: incidence and risk factors. Clin Transplant. 2001;15:154-8.
30. Flechner SM. Current status of renal transplantation patient selection, results, and immunosuppression. Urol Clin North Am. 1994;21:265-82.
31. Luciani J, Frantz P, Thibault P, Ghesquièrre F, Conseiller C, Cousin MT, et al. Early anuria prevention in human kidney transplantation Advantage of fluid load under pulmonary arterial pressure monitoring during surgical period. Transplantation. 1979;28:308-12.
32. Carlier M, Squifflet JP, Pirson Y, Gribomont B, Alexandre GP. Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants. Transplantation. 1982;34:201-4.
33. Thomsen HS, L0kkegaard H, Munck O. Influence of normal central venous pressure on onset of function in renal allografts. Scand J Urol Nephrol. 1987;21:143-5.
34. Dawidson IJ, Ar'Rajab A. Perioperative fluid and drug therapy during cadaver kidney transplantation. Clin Transpl. 1992:267-84.
35. Niemann CU, Eilers H. Abdominal organ transplantation. Minerva Anestesiol. 2010;76:266-75.
36. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134: 172-8.
37. Ferris RL, Kittur DS, Wilasrusmee C, Shah G, Krause E, Ratner L. Early hemodynamic changes after renal transplantation: determinants of low central venous pressure in the recipients and correlation with acute renal dysfunction. Med Sci Monit. 2003;9:CR61-6.
38. De Wilde RB, Schreuder JJ, van den Berg PC, Jansen JR. An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery. Anaesthesia. 2007;62:760-8.
39. Feltracco P, Ori C. Anesthetic management of living transplantation. Minerva Anestesiol. 2010;76:525-33.
40. Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol. 2006;20:265-83.
41. McFarlane C, Lee A. A comparison of Plasmalyte 148 and 0.9% saline for intra-operative fluid replacement. Anaesthesia. 1994;49:779-81.
42. Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus Lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg. 2001;93:817-22.
43. Gan TJ, Bennett-Guerrero E, Phillips-Bute B, Wakeling H, Moskowitz DM, Olufolabi Y, et al. Hextend, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Hextend Study Group. Anesth Analg. 1999;88:992-8.
44. Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983;71:726-35.
45. Ricaurte L, Vargas J, Lozano E, Diaz L, Organ Transplant Group. Anesthesia and kidney transplantation. Transplant Proc. 2013;45:1386-91.
46. Schmid S, Jungwirth B. Anaesthesia for renal transplant surgery: an update. Eur J Anaesthesiol. 2012;29: 552-8.
47. Dawidson I, Peters P, Sagalowsky A, Abshier D, Coorpender L. 51. The effect of intraoperative fluid management on the incidence of acute tubular necrosis. Transplant Proc. 1987;19:2056-7. 52.
48. Willms CD, Dawidson IJ, Dickerman R, Drake D, Sandor ZF, Trevino G. Intraoperative blood volume expansion induces primary function after renal transplantation: a study of 96 paired cadaver kidneys. Transplant Proc. 1991;23:1338-9. 53.
49. Bunn F, Alderson P, Hawkins V. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2003;1:CD001319. Review. Update in: Cochrane Database Syst Rev. 2008;1:CD001319.
50. Laxenaire MC, Charpentier C, Feldman L. Anaphylactoid 54. reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study. Ann Fr Anesth Reanim. 1994;13:301-10.
51. Wilcox CS, Peart WS. Release of renin and angiotensin II into plasma and lymph during hyperchloremia. Am J Physiol. 1987;253:F734-41.
52. Etezadi F, Pourfakhr P, Mojtahedzade M, Najafi A, Moharari RS, Yarandi KK, et al. Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation. Daru. 2012;20:36.
53. McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg. 2013;117:412-21.
54. González VH, Vargas GJ, Echeverri JE, Díaz SM, Mena Y. Valoración preanestésica en el paciente con enfermedad renal crónica (énfasis en riesgo cardiovascular). Rev Colomb Anestesiol. 2013;41:139-45.
2. O'Malley CM, Frumento RJ, Hardy MA, Benvenisty AI, Brentjens TE, Mercer JS, et al. A randomized, double-blind comparison of Lactated Ringer's solution and 0.9% NaCl during renal transplantation. Anesth Analg. 2005;100:1518-24.
3. Khajavi MR, Etezadi F, Moharari RS, Imani F, Meysamie AP, Khashayar P, et al. Effects of normal saline vs. Lactated Ringer's during renal transplantation. Ren Fail. 2008;30:535-9.
4. Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology. 1999;90:1265-70.
5. Prough DS, Bidani A. Hyperchloremic metabolic acidosis is a predictable consequence of intraoperative infusion of 0.9% saline. Anesthesiology. 1999;90:1247-9.
6. Yunos NM, Bellomo R, Story D, Kellum J. Bench-to-bedside review: chloride in critical illness. Crit Care. 2010;14:226.
7. Kaufman D, Kitching AJ, Kellum JA. Acid-base balance. In: Principles of critical care. 3rd edition New York: Gregory & Hall, McGraw-Hill; 2005. p. 1201-8.
8. Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous Lactated Ringer's solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999;88:999-1003.
9. Meier-Kriesche HU, Port FK, Ojo AO, Rudich SM, Hanson JA, Cibrik DM, et al. Effect of waiting time on renal transplant outcome. Kidney Int. 2000;58:1311-7.
10. Lemmens HJ. Kidney transplantation: recent developments and recommendations for anesthetic management. Anesthesiol Clin North Am. 2004;22:651-62.
11. Hadimioglu N, Saadawy I, Saglam T, Ertug Z, Dinckan A. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesth Analg. 2008;107:264-9.
12. Modi MP, Vora KS, Parikh GP, Shah VR. A comparative study of impact of infusion of Ringer's Lactate solution versus normal saline on acid-base balance and serum electrolytes during live related renal transplantation. Saudi J Kidney Dis Transpl. 2012;23:135-7.
13. Nuraei N, Khajenouri R, Soleimani M, Dabbagh A. The effects of intraoperative normal saline versus Lactated Ringer solution on clinical outcomes and laboratory findings in renal transplant patients. Tehran Univ Med J. 2010;68:872-7.
14. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions 5.1.0. The Cochrane collaboration 2011. [Citado 06.02.14]. Available from: http://handbook.cochrane.org/
15. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725-30.
16. Rabbat CG, Thorpe KE, Russell JD, Churchill DN. Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol. 2000;11:917-22.
17. Ojo AO, Hanson JA, Meier-Kriesche H, Okechukwu CN, Wolfe RA, Leichtman AB, et al. Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. J Am Soc Nephrol. 2001;12:589-97.
18. Brunkhorst R, Lufft V, Dannenberg B, Kliem V, Tusch G, Pichlmayr R. Improved survival in patients with type 1 diabetes mellitus after renal transplantation compared with hemodialysis: a case-control study. Transplantation. 2003;76:115-9.
19. U.S. Renal Data System. USRDS 2013 annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD; 2013. [Citado 06.02.14]. Available from: http://www.usrds.org/adr.aspx
20. Locatelli F, Bommer J, London GM, Martín-Malo A, Wanner C, Yaqoob M, et al. Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant. 2001;16:459-68.
21. Arici M, Walls J. End-stage renal disease, atherosclerosis, and cardiovascular mortality: is C-reactive protein the missing link? Kidney Int. 2001;59:407-14.
22. Lagrand WK, Visser CA, Hermens WT, Niessen HW, Verheugt FW, Wolbink GJ, et al. C-reactive protein as a cardiovascular risk factor: more than an epiphenomenon? Circulation. 1999;100:96-102.
23. Yigla M, Nakhoul F, Sabag A, Tov N, Gorevich B, Abassi Z, et al. Pulmonary hypertension in patients with end-stage renal disease. Chest. 2003;123:1577-82.
24. Rivera D, Tejada JH, Medina A, Martinez E, Nieto N. Anesthesia complications in renal transplantation. Rev Colomb Anestesiol. 2011;39:30-7.
25. Social MdP. Informe de pacientes trasplantados por departamento y EPS en Colombia; 2008-2010. [Citado 06.02.14]. Available from: http://www.cuentadealtocosto.org/byblos/Docs/Informe_de-trasplante_renal_enXolombia_segun_Departamento_2011.pdf
26. Cubillos J, Sandoval CL, Andrade E, Hermida NH. Causas que contribuyen a la pérdida del trasplante renal de donante cadaverico en la fundación Surcolombiana de Trasplantes. Febrero 2007 a noviembre 2012, Neiva, Colombia. Rev Colomb Anestesiol. 2014;42:83-9.
27. Hirata ES, Baghin MF, Pereira RI, Alves Filho G, Udelsmann A. Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study. Rev Bras Anestesiol. 2009;59:166-76.
28. Bhosale G, Shah V. Combined spinal-epidural anesthesia for renal transplantation. Transplant Proc. 2008;40:1122-1.
29. Humar A, Kerr SR, Ramcharan T, Gillingham KJ, Matas AJ. Peri-operative cardiac morbidity in kidney transplant recipients: incidence and risk factors. Clin Transplant. 2001;15:154-8.
30. Flechner SM. Current status of renal transplantation patient selection, results, and immunosuppression. Urol Clin North Am. 1994;21:265-82.
31. Luciani J, Frantz P, Thibault P, Ghesquièrre F, Conseiller C, Cousin MT, et al. Early anuria prevention in human kidney transplantation Advantage of fluid load under pulmonary arterial pressure monitoring during surgical period. Transplantation. 1979;28:308-12.
32. Carlier M, Squifflet JP, Pirson Y, Gribomont B, Alexandre GP. Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants. Transplantation. 1982;34:201-4.
33. Thomsen HS, L0kkegaard H, Munck O. Influence of normal central venous pressure on onset of function in renal allografts. Scand J Urol Nephrol. 1987;21:143-5.
34. Dawidson IJ, Ar'Rajab A. Perioperative fluid and drug therapy during cadaver kidney transplantation. Clin Transpl. 1992:267-84.
35. Niemann CU, Eilers H. Abdominal organ transplantation. Minerva Anestesiol. 2010;76:266-75.
36. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134: 172-8.
37. Ferris RL, Kittur DS, Wilasrusmee C, Shah G, Krause E, Ratner L. Early hemodynamic changes after renal transplantation: determinants of low central venous pressure in the recipients and correlation with acute renal dysfunction. Med Sci Monit. 2003;9:CR61-6.
38. De Wilde RB, Schreuder JJ, van den Berg PC, Jansen JR. An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery. Anaesthesia. 2007;62:760-8.
39. Feltracco P, Ori C. Anesthetic management of living transplantation. Minerva Anestesiol. 2010;76:525-33.
40. Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol. 2006;20:265-83.
41. McFarlane C, Lee A. A comparison of Plasmalyte 148 and 0.9% saline for intra-operative fluid replacement. Anaesthesia. 1994;49:779-81.
42. Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus Lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg. 2001;93:817-22.
43. Gan TJ, Bennett-Guerrero E, Phillips-Bute B, Wakeling H, Moskowitz DM, Olufolabi Y, et al. Hextend, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Hextend Study Group. Anesth Analg. 1999;88:992-8.
44. Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983;71:726-35.
45. Ricaurte L, Vargas J, Lozano E, Diaz L, Organ Transplant Group. Anesthesia and kidney transplantation. Transplant Proc. 2013;45:1386-91.
46. Schmid S, Jungwirth B. Anaesthesia for renal transplant surgery: an update. Eur J Anaesthesiol. 2012;29: 552-8.
47. Dawidson I, Peters P, Sagalowsky A, Abshier D, Coorpender L. 51. The effect of intraoperative fluid management on the incidence of acute tubular necrosis. Transplant Proc. 1987;19:2056-7. 52.
48. Willms CD, Dawidson IJ, Dickerman R, Drake D, Sandor ZF, Trevino G. Intraoperative blood volume expansion induces primary function after renal transplantation: a study of 96 paired cadaver kidneys. Transplant Proc. 1991;23:1338-9. 53.
49. Bunn F, Alderson P, Hawkins V. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2003;1:CD001319. Review. Update in: Cochrane Database Syst Rev. 2008;1:CD001319.
50. Laxenaire MC, Charpentier C, Feldman L. Anaphylactoid 54. reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study. Ann Fr Anesth Reanim. 1994;13:301-10.
51. Wilcox CS, Peart WS. Release of renin and angiotensin II into plasma and lymph during hyperchloremia. Am J Physiol. 1987;253:F734-41.
52. Etezadi F, Pourfakhr P, Mojtahedzade M, Najafi A, Moharari RS, Yarandi KK, et al. Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation. Daru. 2012;20:36.
53. McCluskey SA, Karkouti K, Wijeysundera D, Minkovich L, Tait G, Beattie WS. Hyperchloremia after noncardiac surgery is independently associated with increased morbidity and mortality: a propensity-matched cohort study. Anesth Analg. 2013;117:412-21.
54. González VH, Vargas GJ, Echeverri JE, Díaz SM, Mena Y. Valoración preanestésica en el paciente con enfermedad renal crónica (énfasis en riesgo cardiovascular). Rev Colomb Anestesiol. 2013;41:139-45.
How to Cite
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Trujillo-Zea JA, Aristizábal-Henao N, Fonseca-Ruiz N. Lactated Ringer’s vs. normal saline solution for renal transplantation: Systematic review and meta-analysis. Colomb. J. Anesthesiol. [Internet]. 2015 Jul. 1 [cited 2024 Apr. 19];43(3):194-203. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/156
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How to Cite
1.
Trujillo-Zea JA, Aristizábal-Henao N, Fonseca-Ruiz N. Lactated Ringer’s vs. normal saline solution for renal transplantation: Systematic review and meta-analysis. Colomb. J. Anesthesiol. [Internet]. 2015 Jul. 1 [cited 2024 Apr. 19];43(3):194-203. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/156
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