Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study.
Kumar V, Arya VK, et al.Indian Journal of Anaesthesia 2017; 61(2): 150-156.
Aims
To evaluate perioperative haemodynamic and early graft functioning with the discontinuation of antihypertensive drugs on the morning of surgery in controlled hypertensive end‑stage renal disease (ESRD) patients undergoing renal transplantation.
Interventions
Participants were randomised to receive either placebo tablets or the usual anti‑hypertensive drugs 2 hours prior to surgery.
Participants
120 ESRD patients with hypertension undergoing elective renal transplant surgery under combined epidural general anaesthesia.
Outcomes
The primary outcome measured was the decrease in the incidence of intraoperative hypotension. Other measured outcomes included changes in blood pressure, heart rate and central venous pressure, intravenous fluids, propofol, end‑tidal isoflurane, warm and cold ischaemic time, time interval between revascularisation of graft and onset of diuresis and serum creatinine.
Follow-up
24 hours post-surgery
CET Conclusions
This well designed and well reported double-blind trial investigated the potential benefits of withholding antihypertensive medication on the morning of live-donor renal transplantation. Withholding antihypertensive medications resulted in less intraoperative hypotension and less inotrope use, although clinical outcomes were equivalent between the arms. Methodology is sound, with use of a placebo – this is important given the subjective nature of many of the interventions (use of inotropes etc.). Given the lack of effect on outcomes, coupled with the limited scope (live donor transplants only), the clinical significance is probably quite limited.
Data analysis
Modified intention-to-treat analysis
Trial registration
None