title: Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantation : Prospective, randomized, controlled trial.
abstract: BACKGROUND
  Infusion therapy is one of the most frequently prescribed medications in hospitalized patients. Currently used crystalloid solutes have a variable composition and may therefore influence acid-base status, intracellular and extracellular water content and plasma electrolyte compositions and have a major impact on organ function and outcome. The aim of our study was to investigate whether use of acetate-based balanced crystalloids leads to better hemodynamic stability compared to 0.9% saline.
  
  
  METHODS
  We performed a sub-analysis of a prospective, randomized, controlled trial comparing effects of 0.9% saline or an acetate-buffered, balanced crystalloid during the perioperative period in patients with end-stage renal disease undergoing cadaveric renal transplantation. Need for catecholamine therapy and blood pressure were the primary measures.
  
  
  RESULTS
  A total of 150 patients were included in the study of which 76 were randomized to 0.9% saline while 74 received an acetate-buffered balanced crystalloid. Noradrenaline for cardiocirculatory support during surgery was significantly more often administered in the normal saline group, given earlier and with a higher cumulative dose compared to patients receiving an acetate-buffered balanced crystalloid (30% versus 15%, p = 0.027; 68 ± 45 µg/kg versus 75 ± 60 µg/kg, p = 0.0055 and 0.000492 µg/kg body weight/min, ±0.002311 versus 0.000107 µg/kg/min, ±0.00039, p = 0.04, respectively). Mean minimum arterial blood pressure was significantly lower in patients randomized to 0.9% saline than in patients receiving the balanced infusion solution (57.2 [SD 8.7] versus 60.3 [SD 10.2] mm Hg, p = 0.024).
  
  
  CONCLUSIONS
  The use of an acetate-buffered, balanced infusion solution results in reduced need for use of catecholamines and cumulative catecholamine dose for hemodynamic support and in less occurrence of arterial hypotension in the perioperative period. Further research in the field is strongly encouraged.
authors.affiliation: Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. cpfortmueller@gmail.com.
authors.forename: Carmen
authors.initials: C
authors.lastname: Pfortmueller
authors.affiliation: Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital Vienna and Ludwig-Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
authors.forename: Georg-Christian
authors.initials: GC
authors.lastname: Funk
authors.affiliation: Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
authors.forename: Eva
authors.initials: E
authors.lastname: Potura
authors.affiliation: Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Reiterer
authors.affiliation: Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Luf
authors.affiliation: Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kabon
authors.affiliation: Department of Nephrology, Medical University of Vienna, Vienna, Austria.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.affiliation: Department of Anesthesiology, General Intensive Care Medicine and Pain Management, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
authors.forename: Edith
authors.initials: E
authors.lastname: Fleischmann
authors.affiliation: Department of Emergency Medicine, Hirslanden - Klinik Im Park, Zurich, Switzerland.
authors.forename: Gregor
authors.initials: G
authors.lastname: Lindner
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000368:Aged; D001317:Austria; D002395:Catecholamines / Q000627:therapeutic use; D000077324:Crystalloid Solutions / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D016030:Kidney Transplantation; D008297:Male; D011446:Prospective Studies; D000077330:Saline Solution / Q000627:therapeutic use*
chemical_list: D000085:Acetates; D002395:Catecholamines; D000077324:Crystalloid Solutions; D000077330:Saline Solution
keywords: Balanced; Crystalloid; Hemodynamic; Renal transplantation; Saline