Perioperative Fluid Management in Kidney Transplantation: Is Volume Overload Still Mandatory for Graft Function?

Gasperi, Andrea De; Narcisi, Simona; Mazza, E.; Bettinelli, Luiz Antônio; Pavani, Marianna; Perrone, Lorena; Grugni, C; Corti, A

doi:10.1016/j.transproceed.2006.01.072

Cited by 66 publications

(56 citation statements)

References 7 publications

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“…Renal transplantation is the typical clinical situation in which considerable amounts of intravenous fluids are administered normally to patients with end-stage renal disease. Indeed, despite some controversies [47], patients undergoing renal transplantation still receive, in many centres, large amounts of intravenous fluids (up to 30 mL kg -1 h -1 ), in the attempt to increase their intravascular volume and therefore improve graft function [48]. A survey recently performed in the United States pointed out that 0.9% NaCl, and 0.9% NaCl-based intravenous solutions, were the most commonly employed intravenous solutions during renal transplantation.…”

Section: Renal Transplantation and Intravenous Fluidsmentioning

confidence: 99%

Intravenous balanced solutions: from physiology to clinical evidence

Länger

Santini

Scotti

et al. 2015

Anaesthesiol Intensive Ther

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Abstract"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Recently, the term "balanced" solution has been also employed to indicate intravenous fluids with low chloride content, being the concentration of this electrolyte the most altered in 0.9% NaCl as compared to plasma, and based upon a suggested detrimental alteration of renal function associated with hyperchloremia. Despite efforts made towards its identification, the ideal balanced solution, with minimal effects on acid-base status, low chloride content, and adequate tonicity, is not yet available. After the accumulation of pre-clinical and clinical physiologic data, in the last three years, several clinical trials, mostly observational and retrospective, have addressed the question of whether the use of balanced solutions has beneficial effects as compared to the standard of care, sometimes even suggesting an improvement in survival. Nonetheless, the first large randomized controlled trial comparing the effects of a balanced vs. unbalanced solutions on renal function in critically-ill patients (SPLIT trial, the 0.9% saline vs. Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy), just recently published, showed identical equipoise between the two treatments. In the present review, we offer a comprehensive and updated summary on this issue, firstly, by providing a full physiological background of balanced solutions; secondly, by summarizing their potential pathophysiologic effects; and lastly, by presenting the clinical evidence available to support their use at the present time.

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Section: Renal Transplantation and Intravenous Fluidsmentioning

confidence: 99%

Intravenous balanced solutions: from physiology to clinical evidence

Länger

Santini

Scotti

et al. 2015

Anaesthesiol Intensive Ther

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“…Traditionally aggressive volume loading has been recommended using volumes up to 30 ml/kg of warmed crystalloid solution, aiming for a CVP >15mm Hg; however patients with pre-existing cardiac disease or impaired cardiac function are at risk of volume overload, leading to pulmonary oedema necessitating a period of postoperative ventilation. More recently it has been suggested that 15 ml/kg, aiming for a CVP 7-9 mmHg at the point of reperfusion may be associated with equally good graft recovery, whilst reducing the risks associated with volume overload 45 Adjuvant drugs are also commonly employed in an attempt to improve graft recovery and function. Evidence for the effectiveness of these agents however is often sparse or contradictory and not supported by the Cochrane review on perioperative renal protection 46, although these studies did not deal with the transplanted kidney.…”

Section: Intraoperative Graft Optimisationmentioning

confidence: 99%

Anaesthesia for Chronic Renal Disease and Renal Transplant: An Update

Verma¹,

Kumar²,

Bhardwaj³

et al. 2015

jemds

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ABSTRACT:Patients with chronic kidney disease have unique pathophysiology relating to both CKD and its underlying cause and therefore present a challenge to anaesthesiologists & surgeons. The aim of this article is to present the features of chronic kidney disease (CKD) that influence the conduct of anaesthesia and to introduce some of the anaesthetic techniques used for this challenging group of patients.

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“…Evidence for detrimental outcomes with older blood include observational data in critical care [102], trauma [103], liver transplantation [104,105], breast reconstruction [106], cardiac surgery [107,108] and cardiology [102,109]. However, there is evidence challenging this association [110][111][112] and other data showing that fresh red cell-associated harm [113]. The temporal relationship between transfusion and morbidity is complicated and storage effects are best resolved by randomised trials.…”

Section: Red Cell Storage Lesionmentioning

confidence: 99%

Red cell transfusion and the immune system

2014

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SummaryUnderstanding the complex immunological consequences of red cell transfusion is essential if we are to use this valuable resource wisely and safely. The decision to transfuse red cells should be made after serious considerations of the associated risks and benefits. Immunological risks of transfusion include major incompatibility reactions and transfusion-related acute lung injury, while other immunological insults such as transfusion-related immunomodulation are relatively underappreciated. Red cell transfusions should be acknowledged as immunological exposures, with consequences weighed against expected benefits. This article reviews immunological consequences and the emerging evidence that may inform risk-benefit considerations in clinical practice.

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Perioperative Fluid Management in Kidney Transplantation: Is Volume Overload Still Mandatory for Graft Function?

Cited by 66 publications

References 7 publications

Intravenous balanced solutions: from physiology to clinical evidence

Intravenous balanced solutions: from physiology to clinical evidence

Anaesthesia for Chronic Renal Disease and Renal Transplant: An Update

Red cell transfusion and the immune system

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