Elsevier

Transplantation Proceedings

Volume 45, Issue 6, July–August 2013, Pages 2191-2196
Transplantation Proceedings

Emerging trends in transplantation
Kidney transplantation
Comparison of the Effects of Normal Saline Versus Plasmalyte on Acid-Base Balance During Living Donor Kidney Transplantation Using the Stewart and Base Excess Methods

https://doi.org/10.1016/j.transproceed.2013.02.124Get rights and content

Abstract

Background

Ischemia-reperfusion injury is an inevitable consequence of kidney transplantation, leading to metabolic acidosis. This study compared the effects of normal saline (NS) and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation using the Stewart and base excess (BE) methods.

Methods

Patients were randomized to an NS group (n = 30) or a Plasmalyte group (n = 30). Arterial blood samples were collected for acid-base analysis after induction of anesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2), and at the end of surgery (T3). In addition serum creatinine and 24-hour urine output were recorded on postoperative days 1,2, and 7. Over the first postoperative 7 days we recorded episodes of graft failure requiring dialysis.

Results

Compared with the Plasmalyte group, the NS group showed significantly lower values of pH, BE, and effective strong ion differences during the postreperfusion period (T2 and T3). Chloride-related values (chloride [Cl], free-water corrected Cl, BEcl) were significantly higher at T1, T2, and T3, indicating hyperchloremic rather than dilutional metabolic acidosis. Early postoperative graft functions in terms of serum creatinine, urine output, and graft failure requiring dialysis were not significantly different between the groups.

Conclusions

Both NS and Plamalyte can be used safely during uncomplicated living donor kidney transplantation. However, Plasmalyte more stably maintains acid-base and electrolyte balance compared with NS especially during the postreperfusion period.

Section snippets

Methods

After obtaining approval from our Institutional Review Board, 60 patients scheduled for elective living donor kidney transplantation between August 2011 and April 2012 were enrolled in this study. Ages of the enrolled patients ranged from 21 to 67 years. All patients were American Society of Anesthesiologist physical status III to IV. Exclusion criteria included severe cardiovascular or respiratory disease.

One day before transplant surgery, patients were assigned to either the NS group (n = 30)

Results

All 60 enrolled patients successfully completed the study. There were no significant differences in patient characteristics between the 2 groups, including duration of kidney ischemia and intraoperative input and output (Table 1). The time from the skin incision to iliac vein clamping was 124 ± 29 minutes in the NS and 127 ± 23 minutes in the Plasmalyte group. The time from iliac vein clamping to reperfusion was 36 ± 6 minutes in the NS vs 35 ± 6 minutes in the Plasmalyte group.

Changes in serum

Discussion

This randomized, double-blinded study showed that compared with Plasmalyte, NS administration worsened metabolic acidosis by significantly reducing pH, BE, and SIDe throughout the postreperfusion period during living donor kidney transplantation. Patients given NS showed hyperchloremic rather than dilutional metabolic acidosis. The beneficial effect of Plasmalyte on acid-base balance during the postreperfusion period, however, was not associated with improved postoperative graft function.

References (21)

There are more references available in the full text version of this article.

Cited by (0)

View full text