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Min, Na, Seul, Hyoung, Won, and Ui: The Effects of Normal Saline Solution versus Hartmann's Solution on the Acid-base and Electrolytes Status and Renal Function after Kidney Transplantation
Original Article

J Korean Soc Transplant 2015;29(4):194-199.

Published online: 10 December 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.4.194

The Effects of Normal Saline Solution versus Hartmann's Solution on the Acid-base and Electrolytes Status and Renal Function after Kidney Transplantation

Young Kim Min, Ph.D.1, Yeon Jeon Na, R.N.2, Ki Hyun Seul, M.D.2, Tae Kim Hyoung, M.D.2, Hyun Cho Won, M.D.2, Jun Park Ui, M.D.2

1Department of Nursing, Ulsan University College of Medicine, Daegu, Korea

2Ulsan, Division of Transplant and Vascular Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

Corresponding author: Ui Jun Park, Division of Transplant and Vascular Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-7315, Fax: 82-53-250-7322 E-mail: parkuijun@gmail.com

Received 19 May 2015       Revised 13 October 2015       Accepted 28 October 2015

Copyright © the Korean Society for Transplantation, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The purpose of this study was to elucidate the effects of fluid on the acid– base and electrolytes status and renal function after kidney transplantation (KT).

Methods

We retrospectively analyzed 103 patients who underwent KT. Analyses were performed separately according to the donor type (living, 52; deceased, 51). In the living donor KT group, 28 patients received normal saline solution (NS) and 24 patients received Hartmann's solution (HS). In the deceased donor KT group, 27 patients received NS, and 24 received HS. The acid– base and electrolyte status, urine volume, and renal function between patients receiving NS and patients receiving HS were compared in each group.

Results

Regardless of donor type, there were no differences in potassium, pH, base excess, PCO2 and HCO3 between HS and NS on immediate postoperative and postoperative day 1. However, changes to neutral acid-base balance in terms of pH, HCO3, and base excess were significantly higher in HS than in NS. In living donor KT, NS increased serum potassium and chloride significantly during fluid therapy. On postoperative day 7, renal function showed no difference between two groups but urine volume was significantly larger in NS than in HS.

Conclusions

HS does not increase the incidence of hyperkalemia after KT. The use of HS resulted in less metabolic acidosis than the use of NS. Renal function was similar but polyuria was more severe in patients who received NS than in those who received HS.

Keywords: Kidney transplantation, Fluid therapy, Electrolytes, Acid-base, Hartman's solution, Normal saline solution

References

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Table 1.
Patients demographics
Variable Living donor KT Deceased donor KT
NS (n=28) HS (n=24) P-value NS (n=27) HS (n=24) P-value
Age (yr) 41.9±11.9 44.9±11.5 0.334 45.2±11.4 48.9±9.4 0.300
Male sex 15 (53.6) 13 (54.2) 0.966 15 (55.6) 16 (66.7) 0.417
Height (cm) 165.3±9.9 164.7±9.4 0.832 162.2±8.3 163.9±7.8 0.460
Weight (kg) 62.7±14.0 64.3±14.6 0.688 58.6±8.7 60.9±7.6 0.335
BMI (kg/m2) 22.7±2.9 23.6±4.4 0.386 22.2±2.0 22.6±2.2 0.428
Cause of ESRD     0.118     0.352
　 Diabetes mellitus 3 (10.7) 9 (37.5)   6 (22.2) 2 (8.3)  
　 Hypertension 1 (3.6) 0   3 (11.1) 1 (4.2)  
　 Glomerulonephritis 17 (60.7) 10 (41.7)   14 (51.9) 15 (62.5)  
　 Others 7 (25.0) 5 (20.8)   4 (14.8) 6 (25.0)  

Data are presented as mean±SD or number (%).

Abbreviations: KT, kidney transplantation; NS, normal saline solution; HS, Hartmann’ s solution; BMI, body mass index; ESRD, end-stage renal disease.

Table 2.
Blood electrolytes and acid-base in normal saline group and Hartmann’ s solution in living donor kidney transplantation
Variable Group Immediate postoperative (T0) Postoperative day 1 (T1) Difference P-value
Serum electolyte          
　 Sodium (mmol/L) NS (n=28) 132.8±3.9 136.3±3.5 3.6±4.6 0.087
  HS (n=24) 134.3±2.8 135.9±2.1 1.6±3.1  
　 Potassium (mmol/L) NS (n=28) 4.0±0.5 4.3±0.4 0.3±0.4 0.029
  HS (n=24) 4.1±0.6 4.2±0.5 0.1±0.5  
　 Chloride (mmol/L) NS (n=28) 98.5±4.8 105.3±4.5 6.8±4.8 ＜0.001
  HS (n=24) 102.2±4.3 103.5±3.5 1.3±3.6  
Acid-base analysis          
　 pH NS (n=28) 7.35±0.44 7.37±0.36 0.02±0.04 0.030
  HS (n=24) 7.33±0.58 7.38±0.38 0.05±0.05  
　 PCO2 (mmHg) NS (n=28) 37.3±3.7 35.5±3.3 −1.8±3.8 0.531
  HS (n=24) 38.9±4.3 37.7±3.2 −1.2±3.2  
　 HCO3 (mmol/L) NS (n=28) 24.0±5.7 20.8±3.9 −3.4±5.8 0.009
  HS (n=24) 20.5±4.0 22.1±2.9 1.7±2.6  
　 BE (mmol/L) NS (n=28) −4.2±3.1 −4.1±2.5 0.1±2.5 0.005
  HS (n=24) −4.6±4.4 −2.2±3.10 2.4±2.9  

Data are presented as mean±SD.

Abbreviations: NS, normal saline solution; HS, Hartmann’ s solution; BE, base excess.

Table 3.
Allograft renal function and urine volume on postoperative day 7
Variable NS HS P-value
Living donor KT      
　 eGFR (mL/min/1.73 m2) 89.2±28.8 81.8±21.6 0.307
　 Urine volume (mL/day) 10,896.4±3,889.6 8,811.3±3,485.2 0.049
Deceased donor KT      
　 eGFR (mL/min/1.73 m2) 59.7±34.1 61.3±30.8 0.860
Urine volume (mL/day) 6,871.1±3,579.3 4,996.6±2,361.1 0.031

Data are presented as mean±SD.

Abbreviations: NS, normal saline solution; HS, Hartmann’ s solution; KT, kidney transplantation; eGFR, epidermal growth factor receptor.

Table 4.
Blood electrolytes and acid-base in normal saline group and Hartmann’ s solution in deceased donor kidney transplantation
Variable Group Immediate postoperative (T0) Postoperative day 1 (T1) Difference P-value
Serum electolyte          
Sodium (mmol/L) NS (n=27) 134.8±3.8 135.7±4.1 0.9±5.5 0.081
  HS (n=24) 132.9±2.6 134.7±2.6 1.8±2.6  
　 Potassium (mmol/L) NS (n=27) 4.7±0.6 4.5±0.7 −0.2±0.7 0.121
  HS (n=24) 4.5±0.2 4.6±0.9 0.1±0.7  
　 Chloride (mmol/L) NS (n=27) 98.8±3.8 100.1±4.7 1.3±6.0 0.243
  HS (n=24) 99.9±2.7 99.0±2.6 −0.3±3.7  
Acid-base analysis          
　 pH NS (n=27) 7.37±0.52 7.36±0.04 −0.01±0.07 0.006
  HS (n=24) 7.33±0.44 7.38±0.05 0.05±0.07  
　 PCO2 (mmHg) NS (n=27) 38.1±5.4 38.7±3.7 1.1±5.1 0.807
  HS (n=24) 37.8±5.4 39.3±4.3 1.5±5.8  
　 HCO3 (mmol/L) NS (n=27) 21.9±2.7 21.9±2.7 0.1±3.0 0.002
  HS (n=24) 19.3±2.4 23.2±4.4 3.9±4.7  
　 BE (mmol/L) NS (n=27) −1.7±4.7 −1.9±5.6 −0.1±7.5 0.009
  HS (n=24) −5.2±2.8 −1.6±4.7 3.6±5.8  

Data are presented as mean±SD.

Abbreviations: NS, normal saline solution; HS, Hartmann’ s solution; BE, base excess.

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