Saudi Journal of Anaesthesia

LETTERS TO EDITOR
Year
: 2022  |  Volume : 16  |  Issue : 4  |  Page : 507--508

Influence of normal saline on delayed graft function in kidney transplantation


Ashraf M El-Molla 
 Department of Anesthesiology, Misr University for Science and Technology, Cairo, Egypt

Correspondence Address:
Ashraf M El-Molla
Department of Anesthesiology, Misr University for Science and Technology, Cairo
Egypt




How to cite this article:
El-Molla AM. Influence of normal saline on delayed graft function in kidney transplantation.Saudi J Anaesth 2022;16:507-508


How to cite this URL:
El-Molla AM. Influence of normal saline on delayed graft function in kidney transplantation. Saudi J Anaesth [serial online] 2022 [cited 2022 Dec 9 ];16:507-508
Available from: https://www.saudija.org/text.asp?2022/16/4/507/355512


Full Text



Dear Editor,

I read with interest the original article “Crystalloid fluids and delayed graft function in kidney transplant: A cohort study.”[1] This study included 138 patients who were categorized into three unequal groups: those who received plasmaLyte were 100 patients, and delayed graft function (DGF) was observed in 6 patients only (6% incidence of DGF in plasmaLyte group), whereas those who received normal saline (NS) were 33 patients, and DGF was observed in 6 patients (18% incidence of DGF in NS group). Only 5 patients were received lacted Ringer's solution (RL), and no one developed DGF (0% incidence of DGF in RL group). This study showed that some patients in the NS group developed moderate hyperkalemia and metabolic acidosis which required intervention and stopping of the study.[1] An event that did not happen with the other two groups. Consequently, it may be difficult to make a conclusion in this relatively small sample size, and the incidence of DGF may not be the same with different fluid types. It was found that administration of NS is associated with metabolic acidosis,[2] renal vasoconstriction, and decrease glomerular filtration rate due to chloride-rich content.[3],[4] When comparing NS with balanced crystalloid solutions in nonkidney transplant patients, there was a greater incidence of serious adverse kidney events following NS administration.[5] Interstitial fluid retention and adverse intrarenal microvascular effects are more pronounced with NS infusion.[6]

A retrospective cohort study – included analysis of 2515 patients undergoing kidney transplantation – was done, and the authors concluded that high percentage use of NS is associated with DGF in the recipient.[7] In summary, NS is associated with hyperchloremic metabolic acidosis, hyperkalemia, renal vasoconstriction, and decreased glomerular filtration rate, and it may cause DGF in kidney transplants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1ALKouny A, ALHarbi MK, ALTheaby AR, Aboalsamh G, Fayed A. Crystalloid fluids and delayed graft function in kidney transplant: A cohort study. Saudi J Anaesth 2022;16:38-44.
2Stewart PA. Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983;61:1444-61.
3Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest 1983;71:726-35.
4Li H, Sun SR, Yap JQ, Chen JH, Qian Q. 0.9% saline is neither normal nor physiological. J Zhejiang Univ Sci B 2016;17:181-7.
5Self WH, Semler MW, Wanderer JP, Wang L, Byrne DW, Collins SP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med 2018;378:819-28.
6Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma-lyte ® 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 2012;256:18-24.
7Kolodzie K, Cakmakkaya OS, Boparai ES, Tavakol M, Feiner JR, Kim MO, et al. Perioperative normal saline administration and delayed graft function in patients undergoing kidney transplantation: A retrospective cohort study. Anesthesiology 2021;135:621-32.