The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation

Abstract

BACKGROUND: This study aimed to quantify changes in acid-base balance, potassium and lactate levels as a function of administration of different crystalloid solutions during kidney transplantation, and to determine the ideal fluid for such patients. METHODS: In this double-blind study, patients were randomized to three groups (n = 30 each) to receive either normal saline, lactated Ringer's, or Plasmalyte, all at 20-30 mL • kg • h. Arterial blood analyses were performed before induction of anesthesia, and at 30-min intervals during surgery, and total IV fluids recorded. Urine volume, serum creatinine and BUN, and creatinine clearance were recorded on postoperative days 1, 2, 3, and 7. RESULTS: There was a statistically significant decrease in pH (7.44 ± 0.50 vs 7.36 ± 0.05), base excess (0.4 ± 3.1 vs -4.3 ± 2.1), and a significant increase in serum chloride (104 ± 2 vs 125 ± 3 mM/L) in patients receiving saline during surgery. Lactate levels increased significantly in patients who received Ringer's lactate (0.48 ± 0.29 vs 1.95 ± 0.48). No significant changes in acid-base measures or lactate levels occurred in patients who received Plasmalyte. Potassium levels were not significantly changed in any group. CONCLUSIONS: All three crystalloid solutions can be safely used during uncomplicated, short-duration renal transplants; however, the best metabolic profile is maintained in patients who receive Plasmalyte. © 2008 International Anesthesia Research Society.