Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study

Saini, Vikas; Samra, Tanvir; B, Naveen Naik; Ganesh, Venkata; Garg, Kashish; Sethi, Sameer; Kanwar, Deepesh B; Singh, Sarbpreet; Rawat, Neha; Gorla, Deepkanth

doi:10.7759/cureus.18247

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…However, the role of hyperchloremic acidosis was not associated with delayed graft function, suggesting an alternative chloride-independent mechanism [110]. A prospective study done by Saini et al [111] compared the use of normal saline, Ringer's lactate, and plasma-lyte in 60 renal transplant patients in each group and also found that balanced crystalloid fluid was better than normal saline. Another study that compared all three fluids with each other done by Hadimioglu et al [112] also found that normal saline was associated with a significantly increased amount of chloride and caused a decrease in pH.…”

Section: Role In Kidney Transplantmentioning

confidence: 99%

Crystalloid Solutions in Hospital: A Review of Existing Literature

Panchal¹,

Sivasubramanian²,

Venkata³

2023

Cureus

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Intravenous fluids (IVF) like normal saline (NS) and Ringer's lactate (RL) are often crucial in the management of hospitalized patients. Mishandling these fluids can lead to complications in about 20% of patients receiving them. In this review, we present the current evidence through the identification of observational studies and randomized trials that observed the optimal use of IVF. We found that NS may cause hyperchloremic metabolic acidosis in surgical patients, but there is no clear difference in mortality and long-term outcomes between NS and balanced crystalloids. Critically ill patients, particularly those in sepsis, benefit from balanced crystalloids, as high chloride content fluids like NS increase the risk of complications and mortality. In pancreatitis, NS has been shown to increase the risk of ICU admission when compared to RL; however, there is no significant difference in long-term outcomes and mortality between the fluids. RL is preferred for burns due to its isotonicity and lack of protein, preventing edema formation in an already dehydrated state. Plasma-lyte may resolve diabetic ketoacidosis faster, while prolonged NS use can lead to metabolic acidosis, acute kidney injury, and cerebral edema. In conclusion, NS, RL, and plasmalyte are the most commonly used isotonic IVF in the hospital population. Incorrect choice of fluids in a different clinical scenario can lead to worse outcomes.

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Section: Role In Kidney Transplantmentioning

confidence: 99%

Crystalloid Solutions in Hospital: A Review of Existing Literature

Panchal¹,

Sivasubramanian²,

Venkata³

2023

Cureus

View full text Add to dashboard Cite

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Predictors of Post-operative ABG Changes to Pre-operative Levels in Kidney Transplant Patients, a Cross-Sectional Study

Hashemian,

Ebadzadeh,

Mohammadi

et al. 2024

Nephro-Urol Mon

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Background: Kidney transplant is the treatment of choice for chronic renal failure (CRF), significantly improving patient outcomes. Fluid administration during surgery can lead to the accumulation of acid ions and electrolytes, inducing pH changes from the pre-operative to post-operative period, which may compromise transplant success. The impact of acid-base balance changes on transplant outcomes is crucial, yet research on predictors and arterial blood gas (ABG) changes post-kidney transplant is limited. Understanding ABG changes can enhance perioperative management, early detection of complications, and long-term graft function, thereby optimizing patient care and increasing transplant success rates. Objectives: To assess ABG changes before and after kidney transplant and identify predictors of post-operative acidosis in patients with renal failure through cross-sectional studies. Methods: In a retrospective cohort study, we included 97 patients who had undergone kidney transplant. During surgery, patients received crystalloid fluids, with 49 receiving only normal saline and 48 receiving only Ringer's lactate. Data collection involved the insertion of an arterial line after anesthesia induction, and the first ABG sample was obtained as a pre-operative measure. A post-operative measure was taken at the end of the surgery. Ethical considerations were followed throughout the study. Statistical analysis included paired t-test or Wilcoxon signed-rank test to compare pre- and post-operative ABG measures, with a significance level set at a P-value less than 0.05. Results: Total of 97 patients, which 65 (69.4%) were male and 32 (30.6%) were female and mean age was 38.6 ± 12.2. Variables significantly associated with post-op acidosis were fluid administered (OR: 3.25, 95% CI: 1.45 - 4.58), post-op central venous pressure (CVP) (OR: 2.31, 95% CI: 1.23 - 2.62, p < 0.05), post-op base excess (BE) (OR: 2.16, 95% CI: 1.50 - 2.95, P < 0.05). HCO₃ (P = 0.010), BE (P = 0.002), pH (P = 0.023) were significantly lower in the normal saline group compared to the Ringer's group. Post-op pH and BE was also associated with increased post-op CVP. Post-op acidosis and post-op CVP were significantly associated with post-op BE. Conclusions: Post-operative ABG changes, including decreases in pH and HCO3, are key indicators of transplant outcomes, reflecting graft function and patient stability. These findings highlight the critical need for prompt management of ABG abnormalities to optimize transplant success and minimize complications, making vigilant monitoring a vital part of post-transplant care.

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Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study

Cited by 2 publications

References 15 publications

Crystalloid Solutions in Hospital: A Review of Existing Literature

Crystalloid Solutions in Hospital: A Review of Existing Literature

Predictors of Post-operative ABG Changes to Pre-operative Levels in Kidney Transplant Patients, a Cross-Sectional Study

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