Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantationReportar como inadecuado

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Wiener klinische Wochenschrift

pp 1–7

Prospective, randomized, controlled trialFirst Online: 02 March 2017Received: 08 January 2017Accepted: 06 February 2017DOI: 10.1007-s00508-017-1180-4

Cite this article as: Pfortmueller, C., Funk, GC., Potura, E. et al. Wien Klin Wochenschr 2017. doi:10.1007-s00508-017-1180-4 Summary

BackgroundInfusion therapy is one of the most frequently prescribed medications in hospitalized patients. Currently used crystalloid solutes have a variable composition and may therefore influence acid-base status, intracellular and extracellular water content and plasma electrolyte compositions and have a major impact on organ function and outcome. The aim of our study was to investigate whether use of acetate-based balanced crystalloids leads to better hemodynamic stability compared to 0.9% saline.

MethodsWe performed a sub-analysis of a prospective, randomized, controlled trial comparing effects of 0.9% saline or an acetate-buffered, balanced crystalloid during the perioperative period in patients with end-stage renal disease undergoing cadaveric renal transplantation. Need for catecholamine therapy and blood pressure were the primary measures.

ResultsA total of 150 patients were included in the study of which 76 were randomized to 0.9% saline while 74 received an acetate-buffered balanced crystalloid. Noradrenaline for cardiocirculatory support during surgery was significantly more often administered in the normal saline group, given earlier and with a higher cumulative dose compared to patients receiving an acetate-buffered balanced crystalloid 30% versus 15%, p = 0.027; 68 ± 45 µg-kg versus 75 ± 60 µg-kg, p = 0.0055 and 0.000492 µg-kg body weight-min, ±0.002311 versus 0.000107 µg-kg-min, ±0.00039, p = 0.04, respectively. Mean minimum arterial blood pressure was significantly lower in patients randomized to 0.9% saline than in patients receiving the balanced infusion solution 57.2 SD 8.7 versus 60.3 SD 10.2 mm Hg, p = 0.024.

ConclusionThe use of an acetate-buffered, balanced infusion solution results in reduced need for use of catecholamines and cumulative catecholamine dose for hemodynamic support and in less occurrence of arterial hypotension in the perioperative period. Further research in the field is strongly encouraged.

KeywordsBalanced Crystalloid Hemodynamic Renal transplantation Saline Institutional Review Board IRB contact information The study was approved by the local institutional review board EK 1048-2009 and EK 1828-2014, of the Medical University of Vienna, Austria, and registered at a clinical trials registry NCT01075750. Written informed consent was obtained from every patient included in the study; this report describes a prospective randomized clinical trial. The authors state that every item in the CONSORT checklist is included in the report; Registry Url : Identifier: NCT01075750; this manuscript was screened for plagiarism using Plagiarism Checker.

Autor: Carmen Pfortmueller - Georg-Christian Funk - Eva Potura - Christian Reiterer - Florian Luf - Barbara Kabon - Wilfred Druml


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