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. 2017;8(1):8-16.
Epub 2017 Feb 1.

The Effect of Osmotherapy and Tight Control of Acidosis on Early Graft Function Among Deceased-Donor Kidney Transplant Recipients: A Randomized Controlled Trial

Free PMC article

The Effect of Osmotherapy and Tight Control of Acidosis on Early Graft Function Among Deceased-Donor Kidney Transplant Recipients: A Randomized Controlled Trial

F Etezadi et al. Int J Organ Transplant Med. .
Free PMC article


Background: Reperfusion injury and the acid-base status of the transplant are important factors affecting post-transplantation graft function.

Objective: We hypothesized that infusing hypertonic saline (HS) or tight control of acid-base status of the blood rushing through renal graft using sodium bicarbonate may have beneficial effects on early graft function.

Methods: Candidates for deceased-donor kidney transplant were randomized into three groups. HS group (n=33) received 50 mL/kg normal saline (NS) titrated during operation plus 4 mL/kg of 5% HS just within graft reperfusion phase; bicarbonate group (n=37) was administered 60 mL/kg NS while their metabolic acidosis (base excess ≤5 mEq/L) was tightly corrected every 30 min with sodium bicarbonate; and a control group (n=36) that received 60 mL/kg normal saline while they were administered sodium bicarbonate only, if they encountered severe metabolic acidosis (base excess ≤15 mEq/L). The primary outcome was defined as early post-operative renal function evaluated based on serial serum creatinine levels. The study was registered in Iranian Registry of Clinical Trials (IRCT2013122815841N19).

Results: Post-operative early graft function improved significantly during the first 3 days in the intervention groups (p<0.05). However, that beneficial effect no longer remained at the same level after the day four.

Conclusion: Timely administration of HS or tight control of metabolic acidosis with sodium bicarbonate infusion improve early renal function during renal transplant surgery.

Keywords: Acidosis; Bicarbonates; Deceased-donor; Kidney transplantation; Saline solution; hypertonic.

Conflict of interest statement

None declared.


Figure 1
Figure 1
CONSORT flow chart for the study
Figure 2
Figure 2
The incidence of delayed, slow, and immediate graft function between sodium bicarbonate, HS, and control groups. The rate of DGF was lower in the sodium bicarbonate and HS groups but the difference is not significant (p=0.07). DGF was defined by need for dialysis within the first week after transplantation. SGF was defined by the serum creatinine level >2.5 mg/dL on the fifth day of kidney transplantation. The remaining graft function was considered IGF. Numbers in parenthesis indicate the number of patents.
Figure 3
Figure 3
Comparison of post-transplantation serum creatinine levels and urine volumes among three studied groups. a) patients treated with sodium bicarbonate or HS, the serum creatinine levels reached <2.5 mg/dL on the second and third day of kidney transplantation, respectively. Patients in the control group had serum creatinine level <2.5 mg/dL at day 6. b) Patients who received sodium bicarbonate or HS had significantly higher urine volume compared with control group at 2, 6, and 24 hours after transplantation.

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