Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation.

Daru 2012; 20(1): 36

Aims
To investigate the effects of sodium bicarbonate infusion on metabolic acidosis in renal transplant recipients up to the seventh post operative day.

Interventions
The experimental group received sodium bicarbonate infusion (8.4%) intra-operatively according to Base Excess measurements, whilst PaCO₂ was maintained. The control group received sodium bicarbonate for cases of severe metabolic acidosis (BE≤-15mEq/L or serum bicarbonate level ≤ 10mEq/L or PH ≤ 7.15).

Participants
120 kidney transplant candidates.

Outcomes
Primary outcomes include serum creatinine levels measured on the first, second, third and seventh postoperative days. Secondary outcomes: urine volume measured during the first six and 24 hours and serum blood urea nitrogen (BUN) levels measured on the first, second, third and seventh days of the post-operative period.

Follow-up
7 days.

CET Conclusions
Living donor renal transplant recipients were randomized to either “tight” metabolic control or “non-tight” control during surgery. The “tight” control targeted base excess of -5 to +5mEq/L using intravenous bicarbonate. The “non-tight” group only received intravenous bicarbonate in the setting of extreme metabolic acidosis (base excess<15 mEq/L, bicarbonate<10 mEq/L or pH<7.15). A confounding factor may be that the mean arterial pressures reported were higher in the “tight” control group than the “non-tight” control group. Better metabolic control during surgery improved early renal function in the first week after transplantation, in terms of initial urine output and serum creatinine.

Jadad score
3

Data analysis
Modified intention-to-treat analysis

Allocation concealment
No

Trial registration
IRCT138902163829N2

Funding source
Not reported