Effects of Plasma-Lyte® and 0.9% saline in renal function after deceased-donor kidney transplant: a randomized controlled trial
Efeitos do Plasma-Lyte® e solução salina a 0,9% na função renal após transplante renal de doador falecido: um estudo controlado randomizado
Paulo do Nascimento Junior, Lucas Esteves Dohler, Cindy Midori Uchida Ogawa, Luís Gustavo Modelli de Andrade, Leandro Gobbo Braz, Norma Sueli Pinheiro Módolo
Abstract
Background
The influence of different crystalloid solutions infused during deceased-donor kidney transplant on the incidence of delayed graft function remains unclear. We investigated the influence of Plasma-Lyte® vs. 0.9% saline on the incidence of delayed graft function in deceased-donor kidney transplant recipients.
Methods
We conducted a single-blind randomized controlled trial of 104 patients aged 18 to 65 years who underwent deceased-donor kidney transplant under general anesthesia. Patients were randomly assigned to receive either Plasma-Lyte® (n = 52) or 0.9% saline (n = 52), at the same infusion volume, for intraoperative fluid replacement. The primary outcome was the occurrence of delayed graft function. Secondary outcomes included metabolic and electrolytic changes at the end of surgery.
Results
Two patients in the Plasma-Lyte® group and one in the 0.9% saline group died postoperatively and were not included for analysis. The incidence of delayed graft function in Plasma-Lyte® and 0.9% saline groups were 60.0% (95% Confidence Interval [95% CI 46.2–72.4]) and 74.5% (95% CI 61.1–84.4), respectively (p = 0.140). Mean (standard deviation) values of immediate postoperative pH and serum chloride levels in Plasma-Lyte® and 0.9% saline groups were 7.306 (0.071) and 7.273 (0.061) (p = 0.013), and 99.6 (4.2) mEq.L-1 and 103.3 (5.6) mEq.L-1, respectively (p < 0.001). All other postoperative metabolic and electrolyte variables were not statistically different at the immediate postoperative period (p > 0.05).
Conclusion
In deceased-donor kidney transplant recipients, the incidence of delayed graft function is not influenced by Plasma-Lyte® or 0.9% saline used for intraoperative fluid replacement.
Keywords
Resumo
Justificativa: A influência de diferentes soluções cristalóides infundidas durante o transplante renal de doador falecido na incidência de função tardia do enxerto permanece incerta. Nós investigamos a influência do Plasma-Lyte® vs. solução salina 0,9% na incidência de função tardia do enxerto em receptores de transplante renal de doador falecido. Métodos: Foi realizado um estudo controlado randomizado simples-cego de 104 pacientes com idades entre 18 e 65 anos submetidos a transplante renal de doador falecido sob anestesia geral. Os pacientes foram aleatoriamente designados para receber Plasma-Lyte® (n=52) ou solução salina 0,9% (n=52), no mesmo volume de infusão, para reposição de fluidos no intraoperatório. O desfecho primário foi a ocorrência de função tardia do enxerto. Os desfechos secundários incluíram alterações metabólicas e eletrolíticas no final da cirurgia. Resultados: Dois pacientes do grupo Plasma-Lyte® e um do grupo soro fisiológico 0,9% morreram no pós-operatório e não foram incluídos para análise. A incidência de função tardia do enxerto nos grupos Plasma-Lyte® e solução salina 0,9% foi de 60,0% [intervalo de confiança de 95% (IC) 46,2–72,4] e 74,5% [IC 95% 61,1–84,4], respectivamente (p=0,140). Os valores médios (desvio padrão) do pH no pós-operatório imediato e dos níveis de cloreto sérico nos grupos Plasma-Lyte® e solução salina 0,9% foram 7,306 (0,071) e 7,273 (0,061) (p=0,013) e 99,6 (4,2) mEq.L-1 e 103,3 (5,6) mEq.L-1, respectivamente (p0,05). Conclusão: Em receptores de transplante renal de doador falecido, a incidência de função tardia do enxerto não é influenciada pelo Plasma-Lyte® ou solução salina a 0,9% utilizada para reposição de fluidos no intraoperatório.
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References
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