Comparison of the effects of normal saline versus plasmalyte on acid-base balance during living donor kidney transplantation using the stewart and base excess methods.
Kim SY, Huh KH, et al.Transplantation Proceedings 2013; 45(6): 2191-2196.
Aims
To evaluate the effects of normal saline and plasmalyte on acid-base status during kidney transplantation, particularly during the reperfusion period and to differentiate between hyperchloremic and dilutional metabolic acidosis.
Interventions
Patients were randomised to receive either normal saline or plasmalyte on acid-base during transplantation.
Participants
60 patients scheduled for elective living donor kidney transplantation.
Outcomes
The outcomes included arterial blood samples, the total volume of administered crystalloid and blood, urine output, levels of serum chloride (Cl¯) and creatinine, and graft failure.
Follow-up
7 days.
CET Conclusions
This small double-blind RCT from Korea compares intraoperative fluid resuscitation with normal saline and plasmalyte in living-donor transplant recipients. The authors demonstrate better maintenance of acid-base balance with plasmalyte, with a reduction in hyperchloraemia and less metabolic acidosis. This did not translate in this group of patients to improved clinical outcomes, with equivalent early graft function. The design of this trial is fairly robust (although the randomisation method is not very clearly described), and the authors do justify their small sample size with a calculation based upon an expected difference in strong ion concentrations. This does mean, however, that the study is likely underpowered to demonstrate any differences in clinical outcomes resulting from the author’s observations.
Data analysis
Per protocol analysis
Trial registration
Not reported