Low- versus High-Chloride Content Intravenous Solutions for Perioperative Patients: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the included studies.

Study included	Study population	Interventions compared	Volume of fluid (liters, ) (low-/high-chloride fluid group)	Follow-up period	Outcome measures
Waters et al., 2001 [21]	Abdominal aortic, aneurysm repair	LR vs. saline	6.90 (5.70–7.90)/7.00 (5.00–8.50)^b	In-hospital	Mortality, AKI, pH value, serum chloride
Takil et al., 2002 [22]	Spine surgery	LR vs. saline	/	12 hours	Mortality, RRT, pH value, serum chloride
O’Malley et al., 2005 [7]	Kidney transplantation	LR vs. saline	/	3 days	RRT, ABT, serum potassium, pH value, serum chloride,
Khajavi et al., 2008 [8]	Kidney transplantation	LR vs. saline	NA	Intraoperative period	RRT, ABT, serum potassium, pH value
Hadimioglu et al., 2008 [23]	Kidney transplantation	LR vs. saline	/	In-hospital	AKI, serum potassium, pH value
Base et al., 2011 [24]	Cardiac surgery	Volyt vs. Volvn^a	/	90 days	Mortality
Volta et al., 2013	Abdominal surgery	Mixed^b vs. amidolite or saline	/	In-hospital	Mortality, ABT
Kim et al., 2013 [9]	Kidney transplantation	Plasma-Lyte vs. saline	/	7 days	RRT, serum chloride
Potura et al., 2015 [10]	Kidney transplantation	EIe vs. saline	2.60 (2.00–3.10)/2.50 (2.00–3.00)^b	7 days	RRT
Song et al., 2015 [26]	Lumbar spinal surgery	Plasma-Lyte vs. saline	/	In-hospital	Mortality
Pofortmueller et al., 2017 [28]	Kidney transplantation	Mixed^c vs. saline	/	In-hospital	Serum chloride
Weinberg et al., 2017 [27]	Kidney transplantation	Plasma-Lyte vs. saline	1.00/1.00	48 hours	Mortality, RRT, ABT, hyperkalaemia, serum potassium, pH value, serum chloride
Pfortmueller et al., 2018 [30]	Abdominal surgery	LR vs. saline	3.10 (1.67-4.92)/3.40 (2.73-4.13)^b	In-hospital	Hyperchloremic metabolic acidosis, catecholamine use
Dey et al., 2018 [14]	Brain tumors	Plasma-Lyte vs. saline	NA	In-hospital	AKI, serum potassium, PH value, serum chloride

LR: lactated Ringer; NA: not available; AKI: acute kidney injury; RRT: renal replacement therapy; ABT: allogenic blood transfusion. ^aVolyt and Volvn are identical in terms of colloidal composition: both are HES 130/0.4. They differ on the amount of chloride (Volyt is a low-chloride colloid and Volvn a high-chloride solution). ^bRange. ^cTetraspan and amidolite are identical in terms of colloidal composition: both are HES 130/0.42. They differ on the amount of chloride (tetraspan is a low-chloride colloid and amidolite a high-chloride solution). ^dA chloride-reduced, acetate-buffered balanced crystalloid (Elomel Isoton ®, Fresenius Kabi Austria GmbH, Graz; osmolality 302 mOsm/kg, base excess 0 mmol/L, Na⁺ 140 mmol/L, K⁺ 5 mmol/L, Cl^– 108 mmol/L, Mg⁺⁺ 1.5 mmol/L, Ca⁺⁺ 2.5 mmol/L, acetate 45 mmol/L). ^eMedian.