236.11: A Comparison of the Effects of Intravenous vs Oral Hydration on Subclinical Acute Kidney Injury in Laparoscopic Donor Nephrectomy: A Randomised Controlled Trial

Abstract

Importance: Laparoscopic and laparoscopic assisted donor nephrectomy is the most common method of donor nephrectomy. Despite improving the outcome for donors by reducing post-operative pain and speeding up recovery, the technique exposes the kidney to additional haemodynamic stresses in terms of extreme position and pneumoperitoneum. Any intervention that could protect the kidney may further improve the residual function of both donated and remaining kidney. Objective: To determine if preoperative intravenous fluids given overnight, prior to morning kidney donation will result in a measurable improvement in intraoperative haemodynamics and a decrease in subclinical acute kidney injury. Trial Design: A single centre, prospective single-blinded randomised controlled trial. Participants: All adult patients aged >18 years of age undergoing live donor laparoscopic hand-assisted nephrectomy eligible to participate. Interventions: Intervention group: The evening prior to surgery, between midnight and 8am, patients in this group will receive three litres of crystalloid solution, IV, in addition to unrestricted oral fluid. Control group: Patients in this group will also be admitted on the evening prior to surgery but will not be given intravenous fluids. They will only receive unrestricted oral fluids. Main Outcomes: The primary outcome will be a rise in, serum biomarker for acute kidney injury, neutrophil-gelatinase associated lipocalin (N-GAL). Secondary outcomes include donor and recipient renal function, DGF, intraoperative haemodynamics, perioperative complications. Results: A total of 76 patients (median [IQR] age, 50 [42-57], 44[57%] male) were randomised (36 to preoperative intravenous fluids and 40 to no intravenous fluids) and followed up for 1 year. Serum N-GAL was significantly lower immediately post laparoscopic donation in the intervention group (median [95% CI] intravenous fluids, 95ng/ml [68-133] vs control, 131ng/ml [103-156]; P<.036) but not significantly different at day one post operatively. There was no significant difference between groups in renal function of donors at 6 weeks and 1 year post donation. Intraoperative urine output was significantly higher in the intervention group, but all haemodynamic parameters demonstrated a similar trend between both groups with no significant differences. Conclusions: Intravenous hydration prior to laparoscopic donor nephrectomy statistically reduces serum N-GAL post operatively but is unlikely to be clinically significant. Therefore, patients undergoing laparoscopic kidney donation would not seem to benefit from admission the day prior to surgery, for intravenous fluid hydration, and could be admitted the day of surgery in keeping with the principles of enhanced recovery protocols.