Fluid management of peri operative period of kidney transplantation is crucial to drive volemia, acid/base and electrolyte balance, as renal function is usually absent or deeply reduced. Saline perfusion has been associated to an increase of the risk to develop hyperchloremic acidosis. Balanced solutions such as Plasmalyte 148, with a reduced concentration of chloride, are likely to ameliorate acid/base balance compared to saline. In our study, we aimed to compare a saline-based fluid management period of time to a Plasmalyte-based period.

All patients transplanted in our center between September 2011 and June 2017 were included in the analysis. Before January 2015, the peri operative management was made of saline 0.9% and after this date, all patients received Plasmalyte during and the week after the transplantation. All patients received diuretics and an anticalcineurin based triple regimen with an induction by basiliximab or anti-thymocytes polyclonal antibodies. Electrolytes serum concentration were analyzed at Day 0, Day 1, Day 3.

A total of 422 patients were finally included, wit 216 patients in the saline group and 206 in the Plasmalyte group. No difference between groups were noted regarding age (55 years old), sex ratio (65% male), weight (72 kg), hypertension, diabetes, HLA mismatches. More living donor based transplantation were performed in the Plasmalyte group. The amount of infused chloride was significantly lower in the Plasmalyte group during surgery (383 mmol vs. 487, p<0.001) and the two following days (1030 vs 1275 mmol, p<0.001). The difference in bicarbonate concentration between two groups was significant each days after transplantation (Day 0, after surgery, adjusted linear coefficient (Plasmalyte vs. Saline) 1.36 [0.68 ;2.04]; Day 1: 3.51 [2.46 ;4.55]; Day 2: 4.63 [3.52 ;5.74]). No effect on kalemia was noticed.

In conclusion, the use of balanced solutions during kidney transplantation and the next following days better improves the correction of acidosis compared to Saline solution.

CITATION INFORMATION: Maillard N., Chraka H., Claisse G., Alamartine E., Molliex S., Mariat C. Impact of Balanced Solutions on Acid Base Disorders during and after Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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