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Plasma electrolyte imbalance in pediatric kidney transplant recipients

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. Green open access

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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.

Type: Article
Title: Plasma electrolyte imbalance in pediatric kidney transplant recipients
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/petr.13411
Publisher version: https://doi.org/10.1111/petr.13411
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Kidney transplantation, Water-Electrolyte Imbalance, Sodium Chloride, Children, Brain Edema
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
URI: https://discovery.ucl.ac.uk/id/eprint/10068230
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