Vol. 7, Issue 1, Part A (2025)

Background: The preferred treatment for end-stage renal disease (ESRD) is renal transplantation; however, electrolyte and acid-base imbalances are often associated with this procedure. The intraoperative crystalloid solution chosen may have an impact on these parameters.

Objective: To compare the effects of normal saline (NS) and lactated Ringer’s (LR) solutions on acid–base balance, electrolyte levels, and hemodynamic stability during renal transplantation.

Methods: In this randomized controlled trial, 38 ESRD patients (aged 18–60 years, ASA class III–IV) undergoing kidney transplantation were equally assigned to receive either NS (n=19) or LR (n=19) intraoperatively. Standard anesthetic and surgical protocols were applied. Arterial blood gases, serum electrolytes (Na⁺, K⁺, Cl⁻, HCO₃⁻), central venous pressure (CVP), and urine output (UOP) were measured at baseline and surgery completion.

Results: Serum sodium and chloride levels did not significantly change during surgery in either group. There were no appreciable differences between the two groups' pH and bicarbonate levels. Serum potassium levels in the NS group increased significantly (4.22±0.4 to 4.45±0.4 mmol/L, p=0.001), whereas they decreased somewhat (4.4±0.4 to 4.3±0.4 mmol/L, p=0.009) in the LR group. The CVP values were similar for the two groups. With no discernible intergroup variation, UOP increased significantly in both groups (p<0.0001).

Conclusion: Both NS and LR maintained stable acid–base status and hemodynamics during renal transplantation. However, NS was associated with a greater increase in serum potassium, suggesting that LR may be a more favorable option for minimizing hyperkalemia risk in this setting. Larger multicenter studies are recommended to confirm these findings.