Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148® on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial

@article{Weinberg2017EffectsOI,
  title={Effects of intraoperative and early postoperative normal saline or Plasma-Lyte 148{\textregistered} on hyperkalaemia in deceased donor renal transplantation: a double-blind randomized trial},
  author={L. Weinberg and L. Harris and R. Bellomo and F. Ierino and D. Story and G. Eastwood and M. Collins and L. Churilov and P. Mount},
  journal={BJA: British Journal of Anaesthesia},
  year={2017},
  volume={119},
  pages={606–615}
}
Background Administration of saline in renal transplantation is associated with hyperchloraemic metabolic acidosis, but the effect of normal saline (NS) on the risk of hyperkalaemia or postoperative graft function is uncertain. Methods We compared NS with Plasma-Lyte 148® (PL) given during surgery and for 48 h after surgery in patients undergoing deceased donor renal transplantation. The primary outcome was hyperkalaemia within 48 h after surgery. Secondary outcomes were need for… Expand
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References

SHOWING 1-10 OF 36 REFERENCES
Effects of Normal Saline vs. Lactated Ringer's during Renal Transplantation
TLDR
Compared with NS, LR infusion may lead to a lower serum potassium level and a lower risk of acidosis, while there is major concern of the hypercoagulable state in these patients. Expand
Comparison of the effects of normal saline versus Plasmalyte on acid-base balance during living donor kidney transplantation using the Stewart and base excess methods.
TLDR
Both NS and Plamalyte can be used safely during uncomplicated living donor kidney transplantation, however, Plasmalyte more stably maintains acid-base and electrolyte balance compared with NS especially during the postreperfusion period. Expand
An Acetate-Buffered Balanced Crystalloid Versus 0.9% Saline in Patients with End-Stage Renal Disease Undergoing Cadaveric Renal Transplantation: A Prospective Randomized Controlled Trial
TLDR
The incidence of hyperkalemia differed by less than 17% between groups and use of balanced crystalloid resulted in less hyperchloremia and metabolic acidosis. Expand
A Randomized, Double-Blind Comparison of Lactated Ringer’s Solution and 0.9% NaCl During Renal Transplantation
TLDR
LR was associated with less hyperkalemia and acidosis compared with NS, and may be a safe choice for IV fluid therapy in patients undergoing kidney transplantation. Expand
The Effect of Different Crystalloid Solutions on Acid-Base Balance and Early Kidney Function After Kidney Transplantation
TLDR
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. Expand
Perioperative fluid management in renal transplantation: a narrative review of the literature
TLDR
It seems peritoneal dialysis pretransplant is associated with less delayed graft function, whereas the preference of dialysis post‐transplant is not yet well‐founded, andCrystalloid solutions not exerting any specific side‐effects are the first choice for volume replacement in kidney transplantation. Expand
Frequency of hyperkalemia in recipients of simultaneous pancreas and kidney transplants with bladder drainage.
TLDR
SPK recipients appear to have a greater incidence of hyperkalemia than kidney alone transplant recipients, and this difference cannot be explained by higher acute CsA levels, other medications, or worse renal function. Expand
A Randomized, Controlled, Double-Blind Crossover Study on the Effects of 2-L Infusions of 0.9% Saline and Plasma-Lyte® 148 on Renal Blood Flow Velocity and Renal Cortical Tissue Perfusion in Healthy Volunteers
TLDR
This is the first human study to demonstrate that intravenous infusion of 0.9% saline results in reductions in renal blood flow velocity and renal cortical tissue perfusion, which has implications for intravenous fluid therapy in perioperative and critically ill patients. Expand
Creatinine Reduction Ratio: A Useful Marker to Identify Medium and High-Risk Renal Transplants
TLDR
This study shows CRR2 influences long-term graft outcomes and unlike the original description, patients with ND-DGF carry an intermediate risk and perhaps should be considered on day 2 for alternative treatment protocols. Expand
Prevalence and Prognosis of Hyperkalemia in Patients with Acute Myocardial Infarction.
TLDR
Higher maximum potassium levels and number ofhyperkalemic events are associated with a steep mortality increase, with higher risks for adverse outcomes observed even at mild levels of hyperkalemia. Expand
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