Treatment of Metabolic Acidosis in Altering Inflammatory Biomarkers in Renal Transplant Recipients; A Randomized Clinical Trial

Abstract

Background: Metabolic acidosis following kidney transplantation can lead to several undesirable effects such as disturbing the protein balance resulting in a negative nitrogen equilibrium, increased protein degradation, and essential amino acid oxidation. Objectives: The current study aimed tocompare the effect of normal saline as a common crystalloid in kidney transplant surgery to reduce the risk of hyperkalemia and sodium bicarbonate on the metabolic acidosis rate after renal transplantation. Methods: A total of 40 patients with end-stage renal disease (ESRD) and candidates receiving renal transplant from a living donor referring to the kidney transplantation department of a University affiliated hospital, Tehran, Iran, that meeting the inclusion criteria of this study, were randomly assigned to the intervention group, who were treated with sodium bicarbonate, and the control group, who were treated with normal saline. The primary outcomes measured in this study were acidosis biomarkers including BE, HCO3, PaCO2, and PH and the secondary outcomes included some inflammatory biomarkers and some renal function biomarkers. Results: The mean ± standard deviation of age in the intervention and control groups was 44.4 ± 12.4 and 40.0 ± 13.0, respectively (P = 0.01). A total of 29 of the participants were male (14 in the intervention group and 15 in the control group), and 11 of them (six in the intervention group and five in the control group) were female. The mean ± standard deviation of change in the concentration of PH, BE, HCO3, and PaCO2 in the intervention and control groups was 0.01 ± 0.1 and -0.08 ± 0.1 (P < 0.001); 0.61 ± 4.2 and -3.8 ± 2.6 (P < 0.001); 0.36 ± 2.9 and -2.67 ± 2.1 (P: 0.001); and 0.8 ± 5.4 and 1.4 ± 5.3 (P: 0.799), respectively. Conclusions: The present study revealed that the patients who received sodium bicarbonate had a better status than the normal saline recipients in terms of the maintenance of acid-base homeostasis, inflammatory indexes, and renal function.