Association between perioperative normal saline and delayed graft function in deceased-donor kidney transplantation: a retrospective observational study.

Nicolas Nesseler, Alexandre Rached, James T Ross, Yoann Launey, Cécile Vigneau, Karim Bensalah, Hélène Beloeil, Yannick Mallédant, Ronan Garlantezec, Philippe Seguin

Canadian journal of anaesthesia = Journal canadien d'anesthesie 2020 Apr

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Isotonic 0.9% sodium chloride (normal saline; NS) solution use is common, but its high chloride content has been shown to contribute to acid-base disturbances and acute kidney injury (AKI). As kidney transplant recipients are at high risk of postoperative AKI and renal replacement therapy, we aimed to evaluate the impact of perioperative NS administration on graft function after kidney transplantation. All adult patients undergoing deceased-donor kidney transplantation between January 2010 and December 2014 at the Rennes University Hospital were included. Logistic regression models were constructed to evaluate the association of hyperchloremia and hyperchloremic acidosis on delayed graft function (DGF), defined as the need for renal replacement therapy within the first week after transplantation. Three hundred and fifty-nine patients were included, 20% developed DGF. The mean (standard deviation) volume of NS infused in the operating room and in the standard postoperative intensive care unit stay was 4,832 (2,242) mL. In the first 24 postoperative hours, 11% of patients developed hyperchloremia and 11% developed hyperchloremic acidosis. These outcomes were not associated with significantly higher total volumes of NS administration or with DGF. In contrast, multivariable analysis showed that cold ischemia time, donor terminal creatinine, and perioperative NS volume were all independent predictors of DGF. Perioperative NS infusion volume was associated with DGF in deceased-donor kidney transplant recipients. Conversely, postoperative hyperchloremia and hyperchloremic acidosis were not associated with an increased risk of DGF, suggesting other mechanisms than a chloride effect.

Citation

Nicolas Nesseler, Alexandre Rached, James T Ross, Yoann Launey, Cécile Vigneau, Karim Bensalah, Hélène Beloeil, Yannick Mallédant, Ronan Garlantezec, Philippe Seguin. Association between perioperative normal saline and delayed graft function in deceased-donor kidney transplantation: a retrospective observational study. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2020 Apr;67(4):421-429