Podcast covers topics like the impact of balanced crystalloids vs saline in kidney transplants, outcomes of fluid resuscitation trials, autoimmune protocol diet, and Michael Collins (the astronaut). Also, discussions on BEST Fluids, delayed graft function, and Hawthorne Effect.
Balanced crystalloids led to decreased rates of delayed graft function and increased urine output in kidney transplant recipients.
Postoperative fluid management practices focused on matching fluid inputs to urine output, regardless of the intervention.
Balanced crystalloids showed improved patient outcomes with lower serum chloride and sodium concentrations, higher bicarbonate concentration, and blood pH post-transplant compared to saline.
Deep dives
Trial Background and Patient Characteristics
The trial focused on comparing balanced crystalloid solutions with normal saline for kidney transplant patients. The patient population was predominantly healthy with a low percentage having type 2 diabetes. In the balanced crystalloid group, patients received a higher mean volume of trial fluid than the saline group, likely due to postoperative clinical practice.
Dialysis and Fluid Administration
A significant observation was that patients in the balanced crystalloid group had decreased rates of delayed graft function (DGF) and higher urine output. The difference in fluid volume administration between the groups was more postoperatively oriented, following the practice of matching fluid inputs to urine output, regardless of knowing which intervention was being administered.
Trial Implications and Fluid Management
The study highlighted the impact of fluid type on patient outcomes, with balanced crystalloids potentially leading to improved urine output and reduced rates of DGF in kidney transplant recipients. The administration of non-trial fluids, with saline being the common choice, reflected standard clinical practices aimed at optimizing postoperative fluid balance.
Comparison between balanced crystalloid and saline groups post transplant
The balanced crystalloid group exhibited lower mean serum chloride and sodium concentrations along with higher mean bicarbonate concentration and blood pH in the first two days after transplant compared to the saline group. Serum potassium, urea, and hemoglobin concentrations did not differ significantly between the groups. Despite prior studies showing lower potassium levels with balanced solutions post transplant, this trial did not show any difference in potassium levels, indicating balanced fluids may not impact potassium significantly.
Primary outcome of delayed graft function and other secondary outcomes
Delayed graft function occurred in 30% of the balanced crystalloid group versus 40% in the saline group post transplant, indicating a beneficial trend for balanced crystalloids. Subgroup analyses favored balanced crystalloid use, especially among patients receiving kidneys after circulatory death. Although other secondary outcomes, like length of stay and mortality, did not significantly differ between the groups, the study highlighted the potential benefits of balanced crystalloids in influencing dialysis sessions and duration for kidney transplant patients.
Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis in NEJM Evidence
A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO) in Kidney International
