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GENERAL ARTICLES

The Effect of Different Crystalloid Solutions on Acid-Base Balance and Early Kidney Function After Kidney Transplantation

Necmiye Hadimioglu, MD^*, Iman Saadawy, MD, Tayyup Saglam, MD^*, Zeki Ertug, MD^*, and Ayhan Dinckan, MD

From the *Department of Anesthesia, Faculty of Medicine, Akdeniz University, Antalya, Turkey; Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt; and Department of General Surgery, Akdeniz University, Antalya, Turkey.

Address correspondence and reprint requests to Necmiye Hadimioglu, MD, Department of Anesthesiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey. Address e-mail to necmiye{at}akdeniz.edu.tr.

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^–1 · h^–1. 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.