title: 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.
abstract: BACKGROUND
  Ischemia-reperfusion injury is an inevitable consequence of kidney transplantation, leading to metabolic acidosis. This study compared the effects of normal saline (NS) and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation using the Stewart and base excess (BE) methods.
  
  
  METHODS
  Patients were randomized to an NS group (n = 30) or a Plasmalyte group (n = 30). Arterial blood samples were collected for acid-base analysis after induction of anesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2), and at the end of surgery (T3). In addition serum creatinine and 24-hour urine output were recorded on postoperative days 1,2, and 7. Over the first postoperative 7 days we recorded episodes of graft failure requiring dialysis.
  
  
  RESULTS
  Compared with the Plasmalyte group, the NS group showed significantly lower values of pH, BE, and effective strong ion differences during the postreperfusion period (T2 and T3). Chloride-related values (chloride [Cl(-)], free-water corrected Cl(-), BEcl) were significantly higher at T1, T2, and T3, indicating hyperchloremic rather than dilutional metabolic acidosis. Early postoperative graft functions in terms of serum creatinine, urine output, and graft failure requiring dialysis were not significantly different between the groups.
  
  
  CONCLUSIONS
  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.
authors: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: S Y
authors: SY
authors: Kim
authors: K H
authors: KH
authors: Huh
authors: J R
authors: JR
authors: Lee
authors: S H
authors: SH
authors: Kim
authors: S H
authors: SH
authors: Jeong
authors: Y S
authors: YS
authors: Choi
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000138:Acidosis / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004573:Electrolytes / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D006435:Renal Dialysis; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D056910:Republic of Korea; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004573:Electrolytes; D010952:Plasma Substitutes; D012965:Sodium Chloride; D003404:Creatinine