Intravenous Fluid Management Practices in Kidney Transplant Patients: A Multicenter Observational Cohort Pilot Study

the Society for the Advancement of Transplant Anesthesia Research Committee Writing Group

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Limited evidence exists with regard to best practices in fluid management during kidney transplantation, which may directly affect the incidence of DGF. The authors of this study embarked on a collaborative observational multicenter pilot study to evaluate fluid administration practices in different transplant centers, with a focus on the relationship between total administered crystalloid volume and its association with DGF. Methods: Twenty consecutive kidney transplant patients were included from 9 academic medical centers in the United States. One hundred eighty patients were included in the final cohort and variables were compared between patients with and without DGF. Administered crystalloid volume was the primary variable of interest; however, additional patient and surgical variables were compared between patients with and without DGF. Variation in crystalloid administration was explored between centers by comparing median administered crystalloid volumes per kilogram of body weight. Also, unadjusted and adjusted logistic regression analyses were performed to determine which variables were independently associated with DGF. Results: Multivariable regression modeling demonstrated that cold ischemic time and ephedrine use during surgery were independently associated with DGF. There was no independent association between administered crystalloid volume and DGF. Conclusion: In this study of patients having kidney transplantation, we did not find an independent association between administered crystalloid volume and DGF, although there was significant variability in crystalloid administration between centers. Our data suggest that DGF was driven mainly by surgical factors such as cold ischemic time. Ephedrine was also independently associated with DGF, which should be explored in future studies.

Original languageEnglish (US)
Pages (from-to)256-264
Number of pages9
JournalSeminars in Cardiothoracic and Vascular Anesthesia
Volume24
Issue number3
DOIs
StatePublished - Sep 1 2020

Keywords

  • colloid
  • creatinine
  • crystalloid
  • delayed graft function
  • donor
  • fluid management
  • kidney
  • transplant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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