Acetate-buffered crystalloid infusate versus infusion of 0.9% saline and hemodynamic stability in patients undergoing renal transplantation : Prospective, randomized, controlled trial

Carmen Pfortmueller, Georg-Christian Funk, Eva Potura, Christian Reiterer, Florian Luf, Barbara Kabon, Wilfred Druml, Edith Fleischmann, Gregor Lindner, Carmen Pfortmueller, Georg-Christian Funk, Eva Potura, Christian Reiterer, Florian Luf, Barbara Kabon, Wilfred Druml, Edith Fleischmann, Gregor Lindner

Abstract

Background: Infusion 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.

Methods: We 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.

Results: A 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).

Conclusion: The 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.

Keywords: Balanced; Crystalloid; Hemodynamic; Renal transplantation; Saline.

Conflict of interest statement

Conflict of interest

C. Pfortmueller, G.-C. Funk, E. Potura, C. Reiterer, F. Luf, B. Kabon, W. Druml, E. Fleischmann, and G. Lindner declare that they have no competing interests.

Ethical standards

The study was approved by the local institutional review board (EK 1048/2009 Oct 2009 and EK 1828/2014 Oct 2014, Chairman Prof. E. Singer), 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.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) flow chart
Fig. 2
Fig. 2
Kaplan Meyer analysis: time to catecholamines
Fig. 3
Fig. 3
Mean (upper panel) and systolic (lower panel) blood pressure levels in patients receiving either 0.9% saline or an acetate-buffered balanced infusion solution
Fig. 4
Fig. 4
Kaplan Meier analysis: probability to need norepinephrine

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Source: PubMed

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