Research Article

Effects of Ringer Lactate Normal Saline Combination versus Normal Saline during Renal Transplantation Surgery on Early Postoperative Outcome

Abstract

Background: Traditionally normal saline is the most common crystalloid solution that is used in transplant surgery. Normal saline (NS) because of the higher risk of acidosis and higher levels of serum chloride may have more deleterious effects in kidney transplant recipients Thus; the aim of this study was to determine the safety of ringer lactate normal saline combination if used during a renal transplant.
Methods: One Hundred adults undergoing kidney transplantations were enrolled in a double-blinded randomized prospective clinical trial. They were divided into two groups in order to receive RL& NS and NS infusion as intraoperative IV fluid replacement therapy. All patients received 40 ml/kg fluid during surgery. Serum chloride, sodium, Cr and BUN were checked before operation and 6hour after surgery. Urine output BUN and Cr was also checked in 1, 3 and 7 day after surgery. At the end of surgery, we corrected the acid base status with bicarbonate according to base excess< -15 or PH<7.15 if needed in both groups.
Results: There was a significant difference in the serum chloride level (p= 0.001) and urine output (p= 0.003) between the two groups at the 6 hours after transplantations. Postoperative BUN and Cr level at 2,3 and 7 days in RL&NS group was significantly lower than group of NS (P= 0.011). Also, urine output during this study time was significantly higher in RL&NS group (p=0.001).
Conclusion: Combination of Ringer lactate &normal saline crystalloid solutions are associated with higher urinary output and most favorited out come in the early post-operative days after renal transplantation surgeries.

1. Kaló Z, Járay J, Nagy J. Economic Evaluation of Kidney Transplantation versus Hemodialysis in Patients with End-Stage Renal Disease in Hungary. Prog Transplant.2001, 11(3):188-93.
2. Pfortmueller C, Funk GC, Potura E, Reiterer C, Luf F, Kabon B, et al. Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantation. Wien Klin Wochenschr. 2017, 129(17-18): 598-604.
3. O'Malley CM, Frumento RJ, Hardy MA, Benvenisty AI, Brentjens TE, Mercer JS, et al. A randomized, double-blind comparison of lactated ringer’s solution and 0.9% NaCl during renal transplantation. Anesth Analg. 2005, 100(5):1518-24.
4. Khajavi MR, Etezadi F, Moharari RS, Imani F, Meysamie AP, Khashayar P, Najafi A. Effects of normal saline vs. lactated ringer’s during renal transplantation. Ren Fail 2008, 30(5):535–539.
5. Weinberg L, Harris L, Bellomo R, Ierino FL, Story D, Eastwood G, et al. Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial. Br J Anaesth. 2017; 119(4):606-615.
6. Pourfakhr P, Shafiei M, Etezadi F, Khajavi MR, Moharari RS. Half Saline-Bicarbonate Solution as Intraoperative Fluid Replacement Therapy Leads to Less Acidosis and Better Early Renal Function During Deceased-Donor Transplant. Exp Clin Transplant. 2019. [Epub ahead of print]
7. Sri G. Yarlagadda, Steven G. Coca, Amit X. Garg, Mona Doshi, Emilio Poggio, Richard J. Marcus, Chirag R. Parikh; Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant. 2008; 23(9):2995-3003.
8. Gooran S, Khajavi MR, Javid A, Dehghani S, Kheiri E, Yaseri AMF, et al. Prognostic Value of Hemoglobin Concentration and Graft Vein Blood Oxygenation on Renal Transplant Outcomes. Exp Clin Transplant. 2017 Sep 30. doi: 10.6002/ect.2016.0370.
9. Hadimioglu N, Saadawy I, Saglam T, Ertug Z, Dinckan A: The effect of different crystalloid solutions on acid–base balance and early kidney function after kidney transplantation. Anesth Analg. 2008, 107(1):264-9.
10. Reid F, Lobo DN, Williams RN, Rowlands BJ, Allison SP. (Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study. Clin Sci (Lond). 2003; 104(1):17–24.
11. Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg. 2012; 256(1):18–24.
12. Krajewski ML, Raghunathan K, Paluszkiewicz SM, Schermer CR, Shaw AD. Meta-analysis of high- versus low-chloride content in perioperative and critical care fluid resuscitation. Br J Surg. 2015; 102(1):24-36.
13. Etezadi F, Pourfakhr P, Mojtahedzade M, Najafi A, Moharari RS, Yarandi KK, et al. Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation. DARU. 2012; 20(1):36.
14. Wan S, Roberts MA, Mount P. Normal saline versus lower-chloride solutions for kidney transplantation. Cochrane Database Syst Rev. 2016; (8):CD010741.
Files
IssueVol 5 No 3 (2019): Summer QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v5i3.1208
Keywords
Normal saline Ringer lactate Renal transplant Graft function
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Pourfakhr P, Sohrabi Nodehi A, Shariefnia HR, Khajavi MR. Effects of Ringer Lactate Normal Saline Combination versus Normal Saline during Renal Transplantation Surgery on Early Postoperative Outcome. Arch Anesth & Crit Care. 2019;5(3):91-94.