Hayes, W;
Longley, C;
Scanlon, N;
Bryant, W;
Stojanovic, J;
Kessaris, N;
Van’t Hoff, W;
... Marks, SD; + view all
(2019)
Plasma electrolyte imbalance in pediatric kidney transplant recipients.
Pediatric Transplantation
, 23
(4)
, Article e13411. 10.1111/petr.13411.
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Abstract
BACKGROUND: In current practice, pediatric kidney transplant recipients receive large volumes of intravenous fluid intraoperatively to establish allograft perfusion, and further fluid to replace urinary and insensible losses postoperatively. Acute electrolyte imbalance can result, with potential for neurological sequelae. We aimed to determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients managed with the current standard intravenous crystalloid regimen. METHODS: A retrospective analysis of plasma electrolytes in the first 72 hours post kidney transplant in 76 children transplanted between 1 January 2015 and 31 January 2018, managed with a standard intravenous fluid strategy used in most UK pediatric transplant centres. RESULTS: Of 76 pediatric transplant recipients of median age 9.9 (range 2.2 – 17.9) years predominantly managed with 0.45% sodium chloride 5% glucose, 45 (59%) developed acute hyponatremia, 23 (30%) hyperkalemia and 43 (57%) non-anion-gap acidosis in the postoperative period. Hyperglycemia occurred in 74 (97%) patients. Hyperkalemia was more prevalent in deceased than live donor recipients (p = 0.003), and was significantly associated with non anion-gap acidosis (p<0.001). Recipient weight was not associated with overt electrolyte imbalance. CONCLUSION: Postoperative plasma electrolyte imbalance is common in pediatric kidney transplant recipients. Current clinical care strategies mitigate the associated risks of neurological sequelae to some degree. Further studies to optimise intravenous fluid therapy and minimise electrolyte disturbance in this group of patients are needed.
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