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Risk of Hyperkalemia in Recipients of Kidneys Preserved with an Intracellular Electrolyte Solution

Carol A. Hirshman, MD^*, Dolores Leon, MD, Gerald Edelstein, MD^*, Mark Brackebusch, MD, Henry Casson, MD, John Barry, MD, and Eugene Fuchs, MD^||

*Assistant Professor of Anesthesiology. Departments of Anesthesiology and Surgery, University of Oregon Health Sciences Center, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201. Instructor in Anesthesiology. Departments of Anesthesiology and Surgery, University of Oregon Health Sciences Center, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201. Associate Professor of Anesthesiology. Departments of Anesthesiology and Surgery, University of Oregon Health Sciences Center, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201. Associate Professor of Surgery. Departments of Anesthesiology and Surgery, University of Oregon Health Sciences Center, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201. ||Assistant Professor of Surgery. Departments of Anesthesiology and Surgery, University of Oregon Health Sciences Center, 3181 SW Sam Jackson Park Road, Portland, Oregon 97201.

Abstract

Presumed hyperkalemic cardiac arrest has been reported following revascularization of kidney grafts preserved with an intracellular electrolyte solution (Collins' solution) containing potassium, 115 meq/L. We measured serum potassium levels immediately prior to and after revascularization in 21 recipients of cadaver kidneys preserved in Collins' solution for 10 to 45 hours and in 12 recipients of living related kidney grafts preserved with a solution containing potassium, 4 meq/L (Ringer's lactate). Following restoration of the circulation to the kidney, serum potassium levels increased a mean of 0.36 ± 0.07 meq/L (p < 0.05) and 0.14 ± 0.08 (p value was not significant) in the recipients of Collins' and Ringer's flushed kidneys, respectively. Twenty of 21 recipients receiving Collins' flushed kidneys and four of 12 receiving Ringer's flushed kidneys required external iliac artery clamping during vascular anastomosis, rendering the leg ischemic. These 24 patients had serum potassium increases of 0.22 ± 0.05 meq/L when circulation to the leg was restored. This was significantly greater (p < 0.05) than that observed in the nine patients in whom the vascular supply to the leg was not interrupted (0.1 ± 0.05 meq/L).

In the 21 recipients of kidneys flushed with Collins' solution, the total increase in serum potassium was 0.45 ± 0.08 (mean ± SE) meq/L (p < 0.02) of which approximately 63% resulted from Collins' solution and 37% from the ischemic leg. In the 12 recipients of kidneys flushed with Ringer's lactate, the mean increase in serum potassium was statistically not significant. Potassium infusion from a kidney flushed with Collins' solution and from the previously ischemic limb can produce an increase in potassium which may be clinically significant in patients with preexisting hyperkalemia.

Key Words: IONS • Potassium • KIDNEY • Transplantation.