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Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study

BACKGROUND: Kidney transplant recipients often receive large volumes of intravenous fluid replacement in the peri-operative period. Administration of 0.9% saline has previously been associated with acidosis, hyperkalaemia and acute kidney injury. The perioperative use of physiologically balanced rep...

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Autores principales: Adwaney, Anamika, Randall, David W, Blunden, Mark J, Prowle, John R, Kirwan, Christopher J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716220/
https://www.ncbi.nlm.nih.gov/pubmed/29225814
http://dx.doi.org/10.1093/ckj/sfx040
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author Adwaney, Anamika
Randall, David W
Blunden, Mark J
Prowle, John R
Kirwan, Christopher J
author_facet Adwaney, Anamika
Randall, David W
Blunden, Mark J
Prowle, John R
Kirwan, Christopher J
author_sort Adwaney, Anamika
collection PubMed
description BACKGROUND: Kidney transplant recipients often receive large volumes of intravenous fluid replacement in the peri-operative period. Administration of 0.9% saline has previously been associated with acidosis, hyperkalaemia and acute kidney injury. The perioperative use of physiologically balanced replacement fluids may reduce the incidence of post-operative renal replacement therapy and hyperkalaemia. METHODS: A retrospective review of consecutive renal transplants before and after a change in perioperative fluid prescription from 0.9% saline to Plasma-Lyte 148. RESULTS: A total of 97 patients were included in the study, 59 receiving exclusively 0.9% saline and 38 receiving exclusively Plasma-Lyte. Patients in the Plasma-Lyte group were less likely to require emergency postoperative dialysis than those receiving 0.9% saline [odds ratio (OR) 0.15 (95% confidence interval 0.03–0.48), P = 0.004], and these patients had more favourable biochemical parameters with less hyperkalaemia, less acidosis and better diuresis. Patients in the Plasma-Lyte group also had a shorter length of hospital stay (7 days versus 11 days; P < 0.0001) and better graft function at 3 months postoperatively (estimated glomerular filtration rate 51 versus 44 mL/min/1.73 m(2); P = 0.03); however, there was no difference in graft function at 1 year. CONCLUSIONS: Plasma-Lyte in the perioperative period is safe in renal transplantation and is associated with a favourable biochemical profile, including a reduced incidence of hyperkalaemia, better diuresis and less frequent use of renal replacement therapy early after surgery. In patients receiving Plasma-Lyte, graft function was better at 3 months, but this difference did not persist up to 1 year after transplantation.
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spelling pubmed-57162202017-12-08 Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study Adwaney, Anamika Randall, David W Blunden, Mark J Prowle, John R Kirwan, Christopher J Clin Kidney J Transplantation BACKGROUND: Kidney transplant recipients often receive large volumes of intravenous fluid replacement in the peri-operative period. Administration of 0.9% saline has previously been associated with acidosis, hyperkalaemia and acute kidney injury. The perioperative use of physiologically balanced replacement fluids may reduce the incidence of post-operative renal replacement therapy and hyperkalaemia. METHODS: A retrospective review of consecutive renal transplants before and after a change in perioperative fluid prescription from 0.9% saline to Plasma-Lyte 148. RESULTS: A total of 97 patients were included in the study, 59 receiving exclusively 0.9% saline and 38 receiving exclusively Plasma-Lyte. Patients in the Plasma-Lyte group were less likely to require emergency postoperative dialysis than those receiving 0.9% saline [odds ratio (OR) 0.15 (95% confidence interval 0.03–0.48), P = 0.004], and these patients had more favourable biochemical parameters with less hyperkalaemia, less acidosis and better diuresis. Patients in the Plasma-Lyte group also had a shorter length of hospital stay (7 days versus 11 days; P < 0.0001) and better graft function at 3 months postoperatively (estimated glomerular filtration rate 51 versus 44 mL/min/1.73 m(2); P = 0.03); however, there was no difference in graft function at 1 year. CONCLUSIONS: Plasma-Lyte in the perioperative period is safe in renal transplantation and is associated with a favourable biochemical profile, including a reduced incidence of hyperkalaemia, better diuresis and less frequent use of renal replacement therapy early after surgery. In patients receiving Plasma-Lyte, graft function was better at 3 months, but this difference did not persist up to 1 year after transplantation. Oxford University Press 2017-12 2017-06-29 /pmc/articles/PMC5716220/ /pubmed/29225814 http://dx.doi.org/10.1093/ckj/sfx040 Text en © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Transplantation
Adwaney, Anamika
Randall, David W
Blunden, Mark J
Prowle, John R
Kirwan, Christopher J
Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
title Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
title_full Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
title_fullStr Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
title_full_unstemmed Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
title_short Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
title_sort perioperative plasma-lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study
topic Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716220/
https://www.ncbi.nlm.nih.gov/pubmed/29225814
http://dx.doi.org/10.1093/ckj/sfx040
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