Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study
| Autor: | Thomas B. Newman, Claus U. Niemann, Kerstin Kolodzie, Özlem Serpil Çakmakkaya, Mehdi Tavakol, Mi-Ok Kim, John Feiner, Eshandeep S Boparai |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_treatment Delayed Graft Function 030204 cardiovascular system & hematology Perioperative Care Cohort Studies 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology medicine Humans Saline Dialysis Kidney transplantation Aged Retrospective Studies business.industry Incidence (epidemiology) Retrospective cohort study Perioperative Odds ratio Middle Aged medicine.disease Kidney Transplantation Anesthesiology and Pain Medicine Anesthesia Cohort Female Saline Solution business |
| Zdroj: | Anesthesiology. 135:621-632 |
| ISSN: | 1528-1175 0003-3022 |
| Popis: | Background Perioperative normal saline administration remains common practice during kidney transplantation. The authors hypothesized that the proportion of balanced crystalloids versus normal saline administered during the perioperative period would be associated with the likelihood of delayed graft function. Methods The authors linked outcome data from a national transplant registry with institutional anesthesia records from 2005 to 2015. The cohort included adult living and deceased donor transplants, and recipients with or without need for dialysis before transplant. The primary exposure was the percent normal saline of the total amount of crystalloids administered perioperatively, categorized into a low (less than or equal to 30%), intermediate (greater than 30% but less than 80%), and high normal saline group (greater than or equal to 80%). The primary outcome was the incidence of delayed graft function, defined as the need for dialysis within 1 week of transplant. The authors adjusted for the following potential confounders and covariates: transplant year, total crystalloid volume, surgical duration, vasopressor infusions, and erythrocyte transfusions; recipient sex, age, body mass index, race, number of human leukocyte antigen mismatches, and dialysis vintage; and donor type, age, and sex. Results The authors analyzed 2,515 records. The incidence of delayed graft function in the low, intermediate, and high normal saline group was 15.8% (61/385), 17.5% (113/646), and 21% (311/1,484), respectively. The adjusted odds ratio (95% CI) for delayed graft function was 1.24 (0.85 to 1.81) for the intermediate and 1.55 (1.09 to 2.19) for the high normal saline group compared with the low normal saline group. For deceased donor transplants, delayed graft function in the low, intermediate, and high normal saline group was 24% (54/225 [reference]), 28.6% (99/346; adjusted odds ratio, 1.28 [0.85 to 1.93]), and 30.8% (277/901; adjusted odds ratio, 1.52 [1.05 to 2.21]); and for living donor transplants, 4.4% (7/160 [reference]), 4.7% (14/300; adjusted odds ratio, 1.15 [0.42 to 3.10]), and 5.8% (34/583; adjusted odds ratio, 1.66 [0.65 to 4.25]), respectively. Conclusions High percent normal saline administration is associated with delayed graft function in kidney transplant recipients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New |
| Databáze: | OpenAIRE |
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