Kidney Transplant; Complications, Renal Failure Chronic
Conditions
Keywords
kidney transplantation, preload index, stroke volume variation, goad-directed therapy
Brief summary
The investigators sought to compare the effect of two preload targets of stroke volume variation of ≤6% and ≤12% on the postoperative renal function in patients undergoing living donor kidney transplantation. Goal-directed fluid therapy will be performed in both groups to maintain adequate stroke volume, stroke volume variation, mean arterial pressure (or systemic vascular resistance) during kidney transplantation. Only the preload target for giving crystalloid during surgery will be different between groups.
Detailed description
The adequate preload target of fluid management has not yet been established during kidney transplantation. Traditionally, sufficient intravascular volume status has been recommended to maintain perfusion to renal graft. Stroke volume variation was reported to be superior to the traditional target of central venous pressure. In this regard, the investigators sought to compare the effect of two preload targets of stroke volume variation of ≤6% and ≤12% on the postoperative renal function in patients undergoing living donor kidney transplantation. Goal-directed fluid therapy will be performed in both groups to maintain adequate stroke volume, stroke volume variation, mean arterial pressure (or systemic vascular resistance) during kidney transplantation. Only the preload target for giving crystalloid during surgery will be different between groups.
Interventions
OTHERCrystalloid fluid administration with the target of stroke volume variation ≤ 12%
The rate of crystalloid fluid administration will be controlled to achieve the target of stroke volume variation ≤ 12%
OTHERCrystalloid fluid administration with the target of stroke volume variation ≤ 6%
The rate of crystalloid fluid administration will be controlled to achieve the target of stroke volume variation ≤ 6%
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
The patients do not know which group they will be enrolled. The outcome assessor will be blind to the group assignment of the participants.
Intervention model description
A randomized controlled trial of two parallel groups.
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults patients who are undergoing living donor kidney transplantation with continuous radial artery pressure monitoring
Exclusion criteria
* Patients who have cardiac arrhythmia of atrial fibrillation, multiple ventricular premature complex * Cardiac systolic dysfunction with left ventricle ejection fraction \<50% * Continuous arterial pressure monitoring at the site other than radial artery. * Patients who are considered to be intolerant to rapid fluid administration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| serum neutrophil-gelatinase-associated lipocalin (NGAL) | at the end of surgery | urine biomarker of renal injury |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Delayed graft function determined by the incidence of hemodialysis | during the first postoperative week | Delayed graft function determined by the incidence of hemodialysis |
| Delayed graft function determined by urine output (less than 1200 ml) | during the first postoperative day | Delayed graft function determined by urine output (less than 1200 ml) |
| Delayed graft function determined by serum creatinine | during the 48 hours after surgery | Delayed graft function determined by serum creatinine (No decrease in creatinine of more than 10% of preoperative value) |
| Delayed graft function determined by serum creatinine (more than 2.5 mg/dL) | during the 10 days after surgery | Delayed graft function determined by serum creatinine (more than 2.5 mg/dL) |
| Delayed graft function determined by glomerular filtration rate | during the 24 hours after surgery | Delayed graft function determined by glomerular filtration rate (less than 10 ml/min/m2) |
| Delayed graft function determined by serum creatinine (do not decrease less than preoperative value) | during the first postoperative week | Delayed graft function determined by serum creatinine (do not decrease less than preoperative value) |
| serum neutrophil-gelatinase-associated lipocalin (NGAL) | at the anesthesia induction procedure | urine biomarker of renal injury |
| slow graft function | after eight days after surgery | serum creatinine decrease greater than 70% of preoperative value |
| serum creatinine value | first postoperative day | serum creatinine value |
| Incidence of pneumonia | during the first postoperative week | Incidence of pneumonia |
| Incidence of wound infection | during the first postoperative week | Incidence of wound infection |
| Incidence of postoperative bleeding | during the first postoperative week | Incidence of postoperative bleeding |
| hospital length of stay | the first postoperative month | hospital length of stay |
| Immediate graft function | after eight days after surgery | serum creatinine decrease less than 70% of preoperative value |
Countries
South Korea
Outcome results
None listed