Half-saline versus combined normal saline and 1/3-2/3 intravenous fluid therapy in kidney transplantation

Sufficient intravascular volume should be established for optimal graft function after renal transplantation. However, there is no recommendation for the type of fluid therapy post-operatively. We compared half-saline vs. normal saline and 1/3-2/3 intravenous fluid replacement after renal transplantation. We enrolled all patients who underwent kidney transplantation between June 2008 and March 2010 in Golestan Hospital, Ahwaz, southwestern Iran. Patients were randomly divided into two groups using a blinded allocation technique. Group A patients [Case] received half saline, and group B patients [Control] received normal saline and 1/3-2/3 intravenous fluid. According to our protocol, we replaced as much as 100% of hourly urine output in the first day, followed by 90% and 70% of every 2-hour urine output in the 2nd and 3rd days, respectively. Blood pressure and pulse rate were recorded hourly. Serum sodium, potassium, creatinine and pH were assessed twice a day. There were 34 and 36 eligible patients in the case and control groups, respectively. The mean +/- SD 6-hour urine output in the first 5 days after surgery was 2586 +/- 725 mL in the control group and 2764 +/- 758 mL in the case group [p=0.31]. The mean +/- SD serum creatinine level at the end of the 5th post-operative day was 1.3 +/- 0.5 and 1.4 +/- 0.7 mg/dL in the case and control groups, respectively [p=0.56]. Serum creatinine level did not reduce to 1.5 mg/dL or lower in 6 of 36 control subjects and in 4 of 34 cases at the end of the 5th day [p=0.558]. The mean +/- SD time to creatinine level<1.5 mg/dL was 1.3 +/- 1 days in the control group and 1.7 +/- 0.8 days in the case group [p=0.635]. Hyperkalemia occurred in 3 of 36 patients in the control group and in 2 of 34 patients in the case group [p=0.318]. The incidence of hyponatremia in the control group was 11% [4 of 36 patients] vs no patients in the case group [p=0.115]. Either half-saline or normal saline and 1/3-2/3 intravenous solution can be safely used as fluid replacement therapy after kidney transplantation

[Epidemiology of chronic kidney disease in Iran and worldwide]

Chronic kidney disease [CKD] is a worldwide public health problem. Increasing evidence indicates that earlier stages of CKD can be detected through laboratory testing, and that therapeutic interventions implemented early in the course of CKD are effective in slowing or preventing the progression toward end stage renal failure and its associated complications. Each physician should consider how he/she can contribute to an increase in the local screening, identification, and treatment efforts for CKD. Multidisciplinary collaboration between physicians, health care workers, and the government is necessary to halt the progression of CKD. Unfortunately, there is paucity of data concerning epidemiologic characteristics of CKD in Iran, resulting in lost opportunities for prevention. The present article summarizes recent observations about CKD epidemiology, both in Iran and worldwide