Normal Saline Versus Balanced Crystalloid Solutions for Kidney Transplantation

Arslantaş, Reyhan; Dogu, Zuhal; Çevik, Banu

doi:10.1016/j.transproceed.2019.03.050

Cited by 5 publications

(8 citation statements)

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“…The high chloride content causes hyperchloremia, decreases the strong ion difference, and consequently can result in metabolic acidosis. [3][4][5][6][7][8][9][10][11] In turn, metabolic acidosis induces a potassium shift from intra-to extracellular, clinically often resulting in hyperkalemia. In consequence, mean serum potassium levels were actually higher in kidney transplant recipients who received normal saline as compared with balanced crystalloids in several studies.…”

Section: Editor's Perspectivementioning

confidence: 99%

Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study

et al. 2021

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Background Perioperative normal saline administration remains common practice during kidney transplantation. The authors hypothesized that the proportion of balanced crystalloids versus normal saline administered during the perioperative period would be associated with the likelihood of delayed graft function. Methods The authors linked outcome data from a national transplant registry with institutional anesthesia records from 2005 to 2015. The cohort included adult living and deceased donor transplants, and recipients with or without need for dialysis before transplant. The primary exposure was the percent normal saline of the total amount of crystalloids administered perioperatively, categorized into a low (less than or equal to 30%), intermediate (greater than 30% but less than 80%), and high normal saline group (greater than or equal to 80%). The primary outcome was the incidence of delayed graft function, defined as the need for dialysis within 1 week of transplant. The authors adjusted for the following potential confounders and covariates: transplant year, total crystalloid volume, surgical duration, vasopressor infusions, and erythrocyte transfusions; recipient sex, age, body mass index, race, number of human leukocyte antigen mismatches, and dialysis vintage; and donor type, age, and sex. Results The authors analyzed 2,515 records. The incidence of delayed graft function in the low, intermediate, and high normal saline group was 15.8% (61/385), 17.5% (113/646), and 21% (311/1,484), respectively. The adjusted odds ratio (95% CI) for delayed graft function was 1.24 (0.85 to 1.81) for the intermediate and 1.55 (1.09 to 2.19) for the high normal saline group compared with the low normal saline group. For deceased donor transplants, delayed graft function in the low, intermediate, and high normal saline group was 24% (54/225 [reference]), 28.6% (99/346; adjusted odds ratio, 1.28 [0.85 to 1.93]), and 30.8% (277/901; adjusted odds ratio, 1.52 [1.05 to 2.21]); and for living donor transplants, 4.4% (7/160 [reference]), 4.7% (14/300; adjusted odds ratio, 1.15 [0.42 to 3.10]), and 5.8% (34/583; adjusted odds ratio, 1.66 [0.65 to 4.25]), respectively. Conclusions High percent normal saline administration is associated with delayed graft function in kidney transplant recipients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Editor's Perspectivementioning

confidence: 99%

Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study

et al. 2021

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“… 8 9 19 22 23 Crystalloid fluids comprise different components based on their composition of electrolytes and the presence of buffers. Comparisons of clinical outcomes associated with different types of intravenous crystalloids used in kidney transplantation have been reported, 4 8 9 17 19 24 25 26 with each fluid demonstrating its own pros and cons. Recently, a balanced crystalloid solution has shown a better metabolic profile and is preferred in kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported that the use of Plasma-lyte in kidney transplantation is associated with a lower prevalence of hyperchloremic metabolic acidosis 8 17 19 25 and hyperkalemia events than NS. 9 In our study, no significant differences were observed in the incidence of hyperkalemia events between both groups during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Effects of the Type of Intraoperative Fluid in Living Donor Kidney Transplantation: A Single-Center Retrospective Cohort Study

et al. 2022

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Purpose Perioperative fluid management in kidney transplant recipients is crucial to supporting the fluid, acid-base, and electrolyte balance required for graft perfusion. However, the choice of intraoperative crystalloids in kidney transplantation remains controversial. We conducted a single-center retrospective cohort study to evaluate the impact of intraoperative fluids on acid-base and electrolyte balance and graft outcomes. Materials and Methods We included 282 living donor kidney transplant recipients from January 2010 to December 2017. Patients were classified into two groups based on the type of intraoperative crystalloids used (157 patients in the half saline group and 125 patients in the balanced crystalloid solutions group, Plasma-lyte). Results Compared with the half saline group, the Plasma-lyte group showed less metabolic acidosis and hyponatremia during surgery. Hyperkalemia incidence was not significantly different between the two groups. Changes in postoperative graft function assessed by blood urea nitrogen and creatinine were significantly different between the two groups. Patients in the Plasma-lyte group exhibited consistently higher glomerular filtration rates than those in the half saline group at 1 month and 1 year after transplantation after adjusting for demographic differences. Conclusion Intraoperative Plasma-lyte can lead to more favorable results in terms of acid-base balance during kidney transplantation. Patients who received Plasma-lyte showed superior postoperative graft function at 1 month and 1 year after transplantation. Further studies are needed to evaluate the superiority of intraoperative Plasma-lyte over other types of crystalloids in relation to graft outcomes.

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“…We included nine randomized control trials and one retrospective cohort with a total of 726 patients. The main characteristics are provided in Table 1 [7][8][9][10][11][12][13][14][15][16].…”

Section: Literature Searchmentioning

confidence: 99%

Comparison of normal saline solution with low-chloride solutions in renal transplants: a meta-analysis

Jahangir

Sahra

Niazi

et al. 2021

Kidney Res Clin Pract

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Background: Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. Methods: We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of <0.05 was considered statistically significant. Analysis was performed using a random-effects model irrespective of heterogeneity, which was evaluated using I 2 statistics. Results: Nine RCTs and one cohort study with a total of 726 patients were included. After transplantation, serum potassium was significantly lower in the low-chloride group (standardized mean difference compared to NSS group, -0.38 mEq/L; 95% CI, -0.66 to -0.11; p = 0.007). Similarly, postoperative chloride was lower in the low-chloride group (-2.41 mEq/L [-3.34 to -1.48], p < 0.001). No statistically significance was observed in delayed graft function (OR,, p = 0.93), day 3 creatinine (-0.14 mg/dL [-0.46 to 0.18], p = 0.38), or day 7 urine output (-0.08 L [-0.29 to 0.12], p = 0.43). Conclusion: Use of NSS during renal transplant leads to increased incidence of hyperchloremic acidosis with subsequent hyperkalemia, but clinical significance in the form of delayed graft function or postoperative creatinine remains comparable to that of low-chloride solutions.

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Normal Saline Versus Balanced Crystalloid Solutions for Kidney Transplantation

Cited by 5 publications

References 10 publications

Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study

Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study

Effects of the Type of Intraoperative Fluid in Living Donor Kidney Transplantation: A Single-Center Retrospective Cohort Study

Comparison of normal saline solution with low-chloride solutions in renal transplants: a meta-analysis

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