Fluid Management in Kidney Transplantation: Central Venous Pressure Guided vs Esophageal Doppler Monitoring / 대한마취과학회지

ABSTRACT

BACKGROUND: Maximizing renal blood flow during reperfusion of the transplanted kidney could be the key factor to prevent acute tubular necrosis (ATN). To achieve such a goal, augmentation of circulating blood volume is necessary. We evaluated stroke volume monitored or CVP guided volume expansion method and, which method would be better for the outcome. METHODS: Forty three patients (Group I) of 79 patients received maximum hydration guided by CVP maintaining 12-15 mmHg, other 36 patients (Group II) received fluid to achieve maximum SV using esophageal doppler monitor. All patients received albumin (maximal dose < 1 g/kg), mannitol (20%, 200 ml), and furosemide (40 mg) before renal artery reperfusion. Postoperative tests for evaluation of renal function, incidence of ATN and morbidity and hospital stay in patient were investigated. RESULTS: Amount of fluid infused were 3,891 +/- 1,145 ml in Group I and 2,981 +/- 936.4 ml in Group II. Incidence of ATN (Group I; 9.3% and Group II; 8.3%), tests for renal function were not statistically significant in both Group, but two patients in Group I was administered in intensive care unit (ICU). CONCLUSIONS: Lesser fluid was administered in the Group used with SV augmentation than conventional CVP guided group and there was no difference in the incidence of ATN between two group. In kidney transplantation, esophageal doppler monitoring may be better in fluid management than CVP monitoring.