Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study

Area of Science:

• Nephrology
• Anesthesiology
• Transplant Surgery

Background:

• Maintaining optimal acid-base and electrolyte balance is critical during renal transplantation.
• Perioperative crystalloid choice is debated, with normal saline potentially causing hyperchloremic acidosis and balanced salt solutions risking hyperkalemia.

Purpose of the Study:

• To compare the safety and efficacy of normal saline, Ringer's lactate, and Plasmalyte on acid-base balance and electrolytes during living donor kidney transplantation.

Main Methods:

• Randomized controlled trial involving 180 patients undergoing renal transplantation.
• Patients were assigned to normal saline, Ringer's lactate, or Plasmalyte groups.
• Arterial blood gas analysis and electrolyte measurements were performed at multiple intraoperative time points; graft function was monitored postoperatively.

Main Results:

• A statistically significant difference in pH was observed at the end of surgery, with the normal saline group exhibiting more acidosis.
• The normal saline group showed a parallel increase in chloride levels.
• No significant differences were found in early postoperative graft function, including serum creatinine, urine output, or graft failure requiring dialysis.

Conclusions:

• Balanced salt solutions (Plasmalyte, Ringer's lactate) offer superior acid-base and chloride balance compared to normal saline in renal transplant surgery.
• These fluid choices do not appear to affect early graft outcomes.
• Plasmalyte demonstrated a tendency towards better acid-base and electrolyte maintenance, particularly post-reperfusion.