*Purpose: Volume overload in patients with ESRD/CKD V patients is associated with worse operative outcomes and potentially higher rate of delayed graft function, in addition to increased risk for cardiovascular comorbidities such as HTN, left ventricular hypertrophy, and increased mortality due to chronic volume overload and other metabolic derangements. We observe significant postoperative polyuria in kidney transplant (tx) recipients which usually continues as outpatient raising the question of the accuracy of estimated dry weight which we aim for with dialysis since there is no precise way for estimating the ideal weight. Thus we investigated weight differences between the dry weight, the weight on the day of tx, at 1-month & 3-months post-tx in kidney transplant recipients at Erie County Medical Center (ECMC).

*Methods: Retrospective analysis of 244 kidney tx recipients at ECMC from 1/1/2016-12/31/16. Demographics & clinical characteristics were collected. Exclusion criteria: age ≤18 years old, delayed graft function ≥ 1 month, & renal allograft failure within 3 months post-tx, patients who died within 3 months or missing data for the analysis of dry weight.

*Results: There were 65 recipients received pre-emptive transplantation, 140 on hemodialysis (HD) prior to tx and 48 patients on peritoneal dialysis (PD). Overall, age, gender and ethnicity were not statistically different among all three groups. Weights on the day of tx were statistically higher than weights at one-month & three-months post-tx among all groups. Weight loss after kidney transplantation averages (4-6 kg) across all groups even after factoring in volume administered peri-operatively. Patients with higher BMI (29.8 Kg/m2)+ were more difficult to estimate their dry weight within 2.5 Kg with a p-value of 0.006 for underestimation and 0.048 for over estimation. The one-month & three-months post-tx weights were not statistically different among all groups.(tables to follow)

*Conclusions: Fluid management poses a challenging dilemma in dialysis patients which extends to the peri-operative period during kidney transplantation. Our results showed the net weight loss after kidney transplantation averages 4-6 kg, which implies that we might be significantly underestimating the dry weight by average of 4-6 kg, in addition patients with higher BMI (>29.8 kg/m2) tends to be more difficult to estimate. This is greatly important because reducing dry weight even by a relatively small incriments has been associated with improved blood pressure & reduce LVH. This study may help the clinicians to better understand patient’s volume status on dialysis, however further studies are needed to better manage volume status in dialysis patients and discern more impact on future kidney transplants.

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