Perioperative Fluid Management in Patients Receiving Cadaveric Renal Transplants - Effects of Normal Saline Versus Balanced Infusates on the Incidence of Electrolyte and Acid-base Disturbances

Background

Kidney transplantation is the treatment of choice for patients with end-stage-renal-disease (ESRD). Successful renal transplantation improves quality of life and reduces mortality in eligible patients when compared to hemodialysis. In 2007, 44 kidney transplantations per million residents were performed in Austria. The number of patients with a renal transplant has continuously risen in the last ten years. 398 kidney transplantations were performed in Austria in 2007, of which only 61 were of living donors. This underlines the special role of cadaveric kidney transplantation in Austria.

Several studies have demonstrated that adequate intraoperative fluid administration is associated with earlier onset of graft function and improved graft survival in renal transplant recipients. However, which kind of solution should be chosen for the perioperative fluid management of renal transplant recipients remains to be clarified. A non-governmental US survey has shown that normal saline is the most commonly used fluid for renal transplantation. The most common cited reason for the administration of normal saline was the lack of potassium in the solution. Balanced salt type fluids were used in only less than 10% of kidney transplantations.

To our knowledge only three studies compared the effects of lactated ringer's solution versus normal saline in kidney transplantation. Taken together, the application of lactated ringer's solution led to less occurrence of metabolic acidosis, electrolyte derangements and in one study, the appearance of hyperkalemia was eliminated by the use of lactated ringer's instead of normal saline. However, it was also shown that the administration of lactated ringer's during kidney transplantation led to a significant rise in lactate levels compared to those treated with normal salin. Despite the knowledge that lactated ringer's can at least potentially lead to a rise in lactate levels, no studies using acetate based balanced salt type fluids have been performed so far in cadaveric renal transplantation. We therefore propose a prospective study in which patients undergoing cadaveric kidney transplantation will be randomized to receive either a solely acetate buffered balanced salt type fluid or a normal saline for infusion therapy.

Clinical considerations