*Purpose: 0.9% normal saline (NS) has been used as the standard fluid replacement in kidney transplant recipients (KTRs) to prevent dehydration and to improve renal perfusion. It has the potential to cause hyperchloremic metabolic acidosis, which in turn can result in hyperkalemia and lead to delayed graft function (DGF). Electrolyte-A (EA) has a lower amount of chloride and a neutral pH, which may provide more favorable outcomes. The aim is to determine the incidence of DGF post-transplant when comparing NS vs EA for fluid management in KTRs.

*Methods: Single-center, retrospective cohort study in adult KTRs from January 1, 2016 to February 1, 2021. Multi-organ transplant recipients were excluded. Data were collected for two cohorts of recipients, those receiving NS vs EA for their fluid replacement peri- and immediately post-operatively. Primary outcome was incidence of DGF. Secondary outcomes included incidence of hyperkalemia and renal function.

*Results: Total of 244 KTRs in NS group and 263 KTRs in EA group were included and demographics were similar, except for significantly more hypertension as a comorbidity in EA group (NS 77.9% vs EA 85.2%, p=0.04), more alemtuzumab induction in NS group (85.2% vs 75.7%), and more thymoglobulin induction in EA group (8.2% vs 19.4%, p=0.0003). There was no difference in DGF (30.5% vs 25.9%, p=0.54). Logistic regression accounting for confounding variables for all KTRs resulted in fluid treatment having OR 1.06 (CI 0.66-1.7) and for only those receiving a deceased kidney are shown in Table 1. There was no difference between the two groups in potassium at baseline (4.35 vs 4.47 mEq/L, p=0.06), post-operative day 1 (4.8 vs 4.9 mEq/L, p=0.25), 2 (4.63 vs 4.62 mEq/L, p=0.87), or 3 (4.46 vs 4.46 mEq/L, p=0.9) nor in renal function at 1 week (serum creatinine 3.51 vs 3.26 mg/dL, p=0.35; eCrCl 41.5 ml/min vs 41.9 ml/min, p=0.88).

*Conclusions: Based on our results, we are unable to determine a benefit of EA on DGF, but had a higher percent odds of being more harmful.

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