Abstract: SA-PO050

Interim Analysis of Randomised Controlled Trial Comparing Effects of Intravenous versus Oral Hydration on Subclinical AKI in Laparoscopic Live Kidney Donors

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Ghita, Ryan, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Bruce, David, University of Glasgow, Brighton, United Kingdom
  • Mackinnon, Shona, University of Glasgow, Brighton, United Kingdom
  • Aitken, Emma L., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Clancy, Marc J., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
Background

Laparoscopic donor nephrectomy is the gold standard for kidney donation due to improved donor convalescence. Pneumoperitoneum required for this procedure exposes patients to increased risk of renal injury. Intensive pre-operative intravenous hydration has shown to improve intraoperative haemodynamics but shows no improvement to creatinine clearance. This is potentially due to the reduced sensitivity of creatinine as a marker for renal injury in the acute setting. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker with high sensitivity for acute kidney injury.

Methods

Patients were randomised 1:1 to receive 3L of preoperative intravenous fluids or ad-libitum oral hydration. NGAL samples were taken prior to intervention on day -1, day 0 pre- and post-operatively and on day+1. During the procedure, intraoperative urine output and haemodynamics were recorded. Data for baseline characteristics, eGFR from day -1 to 1 year and peri-operative outcomes were collected.

Results

49 patients consented to take part. After removing withdrawals, 19 participants in the control group and 22 participants in the intravenous fluid group were analysed. All baseline characteristics were balanced between groups. On day 1 post-operatively 29.4% of patients in the intravenous fluids group had acute kidney injury compared to 40% of patients in the control group (p=0.529). Mean NGAL level was lower in the intravenous fluid group at every time point however with current numbers this was not found to be statistically significant. Percentage change in eGFR from baseline was also less pronounced in the intravenous fluid group at every time point but again was not statistically significant. Statistical analysis for all other outcomes showed that significant differences between groups were only found for intraoperative urine output and post-pneumoperitoneum stroke volume.

Conclusion

At this midpoint analysis the study was unable to fully establish a definitive effect of pre-operative hydration upon renal function in laparoscopic donor nephrectomy patients. There is a potential reduction in postoperative AKI and improvement of eGFR however a fully powered clinical trial should give definitive findings with relevant clinical applications.