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Plasma electrolyte imbalance in pediatric kidney transplant recipients
Wesley Hayes1,2, Catherine Longley1, Nicola Scanlon1
1Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
Insights
Pediatric kidney transplant recipients frequently experience electrolyte imbalances like hyponatremia and hyperkalemia after surgery. Current fluid management strategies help reduce risks, but further research is needed to optimize care for these young patients.
Area of Science:
- Pediatric Nephrology
- Transplant Medicine
- Critical Care Medicine
Background:
- Pediatric kidney transplant recipients often receive substantial intravenous fluids during and after surgery.
- This practice can lead to acute electrolyte disturbances, potentially causing neurological issues.
- The study investigates electrolyte imbalances in this vulnerable population.
Purpose of the Study:
- To determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients.
- To evaluate the impact of the current standard intravenous crystalloid regimen on electrolyte balance.
- To identify common electrolyte abnormalities following pediatric kidney transplantation.
Main Methods:
- Retrospective analysis of plasma electrolytes in 76 children within 72 hours post-kidney transplant.
- Data collected from January 2015 to January 2018, using a standard UK pediatric transplant center intravenous fluid strategy.
- Analysis focused on hyponatremia, hyperkalemia, non-anion-gap acidosis, and hyperglycemia.
Main Results:
- 59% of patients developed hyponatremia, 30% hyperkalemia, and 57% non-anion-gap acidosis.
- Hyperglycemia was observed in 97% of recipients.
- Hyperkalemia was more common in deceased donor recipients and linked to acidosis; recipient weight was not a factor.
Conclusions:
- Postoperative electrolyte imbalance is a frequent complication in pediatric kidney transplant recipients.
- Current clinical practices offer some protection against neurological sequelae.
- Optimization of intravenous fluid therapy is crucial to minimize electrolyte disturbances in this patient group.
Background:
In current practice, pediatric kidney transplant recipients receive large volumes of intravenous fluid intraoperatively to establish allograft perfusion, and further fluid to replace urinary and insensible losses postoperatively. Acute electrolyte imbalance can result, with potential for neurological sequelae. We aimed to determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients managed with the current standard intravenous crystalloid regimen.
Methods:
A retrospective analysis of plasma electrolytes in the first 72 hours post-kidney transplant in 76 children transplanted between January 1, 2015, and January 31, 2018, managed with a standard intravenous fluid strategy used in most UK pediatric transplant centers.
Results:
Of 76 pediatric transplant recipients of median age 9.9 (range 2.2-17.9) years predominantly managed with 0.45% sodium chloride 5% glucose, 45 (59%) developed acute hyponatremia, 23 (30%) hyperkalemia, and 43 (57%) non-anion-gap acidosis in the postoperative period. Hyperglycemia occurred in 74 (97%) patients. Hyperkalemia was more prevalent in deceased than live donor recipients (P = 0.003) and was significantly associated with non-anion-gap acidosis (P < 0.001). Recipient weight was not associated with overt electrolyte imbalance.
Conclusion:
Postoperative plasma electrolyte imbalance is common in pediatric kidney transplant recipients. Current clinical care strategies mitigate the associated risks of neurological sequelae to some degree. Further studies to optimize intravenous fluid therapy and minimize electrolyte disturbance in this group of patients are needed.
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