title: 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.
abstract: BACKGROUND
  Recent studies have shown a decline in glomerular filtration rate and increased renal vasoconstriction after administration of normal saline when compared with IV solutions with less chloride. In this study, we investigated the impact of normal saline versus a chloride-reduced, acetate-buffered crystalloid on the incidence of hyperkalemia during cadaveric renal transplantation. The incidence of metabolic acidosis and kidney function were secondary aims.
  
  
  METHODS
  In this prospective randomized controlled trial, 150 patients received normal saline or an acetate-buffered balanced crystalloid during and after cadaveric renal transplantation. Venous blood gases were obtained at the start of anesthesia and every 30 minutes until discharge from the postoperative surveillance unit. Serum creatinine and 24-hour urine output were obtained on postoperative days 1, 3, and 7.
  
  
  RESULTS
  Patients received a similar amount of fluid (median: 2625mL [interquartile range: 2000 to 3100] vs 2500 mL [2000 to 3050], P = 0.83). Hyperkalemia, defined as serum potassium >5.9 mmol/L, occurred in 13 patients (17%) in the saline and 15 (21%) in the balanced group (P = 0.56; difference between proportions -0.037 [-16.5% to 8.9%]). Minimum base excess was lower in the saline group compared with the balanced regimen (-4.5 mmol/L [-6 to -2.4] vs -2.6 mmol/L [-4 to -1], P < 0.001) and maximum chloride was significantly higher in the saline group (109 mmol/L [107 to 111] vs 107 mmol/L [105 to 109], P < 0.001). No difference in creatinine or urine output was seen postoperatively. Significantly more patients needed catecholamines in the saline group (30% vs 15%, P = 0.03).
  
  
  CONCLUSIONS
  The incidence of hyperkalemia differed by less than 17% between groups. Use of balanced crystalloid resulted in less hyperchloremia and metabolic acidosis. Significantly more patients in the saline group required administration of catecholamines for circulatory support.
authors.affiliation: From the Department of Anaesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna, Sozialmedizinisches Zentrum Baumgartner Höhe, Vienna, Austria; Department of Nephrology, Medical University of Vienna, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna, Austria; Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria; and Department of Nephrology, Landeskrankenhaus Steyr, Steyr, Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Potura
authors.forename: Gregor
authors.initials: G
authors.lastname: Lindner
authors.forename: Peter
authors.initials: P
authors.lastname: Biesenbach
authors.forename: Georg-Christian
authors.initials: GC
authors.lastname: Funk
authors.forename: Christian
authors.initials: C
authors.lastname: Reiterer
authors.forename: Barbara
authors.initials: B
authors.lastname: Kabon
authors.forename: Christoph
authors.initials: C
authors.lastname: Schwarz
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.forename: Edith
authors.initials: E
authors.lastname: Fleischmann
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D000138:Acidosis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002021:Buffers; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006947:Hyperkalemia / Q000453:epidemiology / Q000209:etiology; D007552:Isotonic Solutions / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D014563:Urodynamics / Q000187:drug effects
chemical_list: D000085:Acetates; D002021:Buffers; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D011188:Potassium