Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/18362
Title: Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial.
Authors: Weinberg, Laurence;Harris, L;Bellomo, Rinaldo;Ierino, F L;Story, David A;Eastwood, Glenn M;Collins, M;Churilov, Leonid;Mount, Peter F
Affiliation: Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Victoria, Australia
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, The University of Melbourne, Parkville, Victoria, Australia
Department of Nephrology, St Vincent's Hospital, Victoria, Australia
Department of Anaesthesia, The University of Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Oct-2017
Citation: British journal of anaesthesia 2017; 119(4): 606-615
Abstract: Administration of saline in renal transplantation is associated with hyperchloraemic metabolic acidosis, but the effect of normal saline (NS) on the risk of hyperkalaemia or postoperative graft function is uncertain. We compared NS with Plasma-Lyte 148® (PL) given during surgery and for 48 h after surgery in patients undergoing deceased donor renal transplantation. The primary outcome was hyperkalaemia within 48 h after surgery. Secondary outcomes were need for hyperkalaemia treatment, change in acid-base status, and graft function. Twenty-five subjects were randomized to NS and 24 to PL. The incidence of hyperkalaemia in the first 48 h after surgery was higher in the NS group; 20 patients (80%) vs 12 patients (50%) in the PL group (risk difference: 0.3; 95% confidence interval: 0.05, 0.55; P=0.037). The mean (sd) peak serum potassium was NS 6.1 (0.8) compared with PL 5.4 (0.9) mmol litre-1 (P=0.009). Sixteen participants (64%) in the NS group required treatment for hyperkalaemia compared with five (21%) in the PL group (P=0.004). Participants receiving NS were more acidaemic [pH 7.32 (0.06) vs 7.39 (0.05), P=0.001] and had higher serum chloride concentrations (107 vs 101 mmol litre-1, P<0.001) at the end of surgery. No differences in the rate of delayed graft function were observed. Subjects receiving PL who did not require dialysis had a greater reduction in creatinine on day 2 (P=0.04). Compared with PL, participants receiving NS had a greater incidence of hyperkalaemia and hyperchloraemia and were more acidaemic. These biochemical differences were not associated with adverse clinical outcomes. Australian New Zealand Clinical Trials Registry: ACTRN12612000023853.
URI: http://ahro.austin.org.au/austinjspui/handle/1/18362
DOI: 10.1093/bja/aex163
ORCID: 0000-0002-9807-6606
0000-0001-7403-7680
0000-0002-1650-8939
0000-0001-7637-3661
PubMed URL: 29121282
Type: Journal Article
Subjects: Plasma-lyte 148
acidosis
crystalloid solutions
delayed graft function
fluid therapy
hyperkalaemia
isotonic solutions
kidney transplantation
sodium chloride
Appears in Collections:Journal articles

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