Gebhard Wagener1, Dmitri Bezinover2, Cynthia Wang3, Elizabeth Kroepfl4, Geraldine Diaz5, Chris Giordano6, James West7, James D Kindscher8, Marina Moguilevitch9, Ramona Nicolau-Raducu10, Raymond M Planinsic11, David M Rosenfeld12, Scott Lindberg13, Roman Schumann14, Evan G Pivalizza15. 1. Columbia University Medical Center, New York, NY. 2. Penn State Hershey Medical Center, Hershey, PA. 3. Greater Los Angeles VA Healthcare System, Los Angeles, CA. 4. Indiana University School of Medicine, Indianapolis, IN. 5. SUNY Downstate Medical Center, Brooklyn, NY. 6. University of Florida, Gainesville, FL. 7. Methodist-LeBonheur Healthcare Memphis, TN. 8. Kansas University, Kansas City, KS. 9. Albert Einstein College of Medicine. Montefiore Medical Center, Bronx, NY. 10. University of Miami/Jackson Memorial Hospital, Miami, FL. 11. University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA. 12. Mayo Clinic Arizona, Phoenix, AZ. 13. Houston Methodist Hospital, Houston, TX. 14. Tufts University School of Medicine, Boston, MA. 15. UTHealth McGovern Medical School, Houston, TX.
Abstract
BACKGROUND: Intraoperative fluid management may affect the outcome after kidney transplantation. However, the amount and type of fluid administered, and monitoring techniques vary greatly between institutions and there are limited prospective randomized trials and meta-analyses to guide fluid management in kidney transplant recipients. METHODS: Members of the American Society of Anesthesiologists (ASA) committee on transplantation reviewed the current literature on the amount and type of fluids (albumin, starches, 0.9% saline, and balanced crystalloid solutions) administered and the different monitors used to assess fluid status, resulting in this consensus statement with recommendations based on the best available evidence. RESULTS: Review of the current literature suggests that starch solutions are associated with increased risk of renal injury in randomized trials and should be avoided in kidney donors and recipients. There is no evidence supporting the routine use of albumin solutions in kidney transplants. Balanced crystalloid solutions such as Lactated Ringer are associated with less acidosis and may lead to less hyperkalemia than 0.9% saline solutions. Central venous pressure is only weakly supported as a tool to assess fluid status. CONCLUSIONS: These recommendations may be useful to anesthesiologists making fluid management decisions during kidney transplantation and facilitate future research on this topic.
BACKGROUND: Intraoperative fluid management may affect the outcome after kidney transplantation. However, the amount and type of fluid administered, and monitoring techniques vary greatly between institutions and there are limited prospective randomized trials and meta-analyses to guide fluid management in kidney transplant recipients. METHODS: Members of the American Society of Anesthesiologists (ASA) committee on transplantation reviewed the current literature on the amount and type of fluids (albumin, starches, 0.9% saline, and balanced crystalloid solutions) administered and the different monitors used to assess fluid status, resulting in this consensus statement with recommendations based on the best available evidence. RESULTS: Review of the current literature suggests that starch solutions are associated with increased risk of renal injury in randomized trials and should be avoided in kidney donors and recipients. There is no evidence supporting the routine use of albumin solutions in kidney transplants. Balanced crystalloid solutions such as Lactated Ringer are associated with less acidosis and may lead to less hyperkalemia than 0.9% saline solutions. Central venous pressure is only weakly supported as a tool to assess fluid status. CONCLUSIONS: These recommendations may be useful to anesthesiologists making fluid management decisions during kidney transplantation and facilitate future research on this topic.
Authors: Vincent Dupont; Anne-Sophie Bonnet-Lebrun; Alice Boileve; Alexandre Debrumetz; Alain Wynckel; Antoine Braconnier; Charlotte Colosio; Laetitia Mokri; Betoul Schvartz; Vincent Vuiblet; Coralie Barbe; Mathieu Jozwiak; Philippe Rieu Journal: Kidney Int Rep Date: 2022-02-22
Authors: M Carron; G Andreatta; E Pesenti; A De Cassai; P Feltracco; F Linassi; M Sergi; C Di Bella; M Di Bello; F Neri; C Silvestre; L Furian; P Navalesi Journal: Perioper Med (Lond) Date: 2022-01-13