In reply: Delayed graft function after kidney transplantation: is saline really responsible?
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CORRESPONDENCE
In reply: Delayed graft function after kidney transplantation: is saline really responsible? Nicolas Nesseler, MD, PhD . James T. Ross, MD . Alexandre Rached, MD . Ronan Garlantezec, MD, PhD
Received: 29 April 2020 / Revised: 29 April 2020 / Accepted: 29 April 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, We thank Dr. Gueret et al. for their interest in our work and would like to address some of their comments.1,2 First, we agree that the abbreviated way we calculated the strong ion difference may be a limitation. This approach was chosen as other components of the strong ion difference, such as lactate or magnesium, were not available in our database. Second, Gueret et al. pointed out that the association between normal saline volume and delayed graft function (DGF) was only present when DGF was defined as the need for any renal replacement therapy (RRT) within one week after transplantation, but not when using the creatinine-based definition of DGF. This is an N. Nesseler, MD, PhD (&) Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France e-mail: [email protected] Universite´ de Rennes, CHU de Rennes, Institut NUMECAN, Rennes, France Universite´ de Rennes, CHU Rennes, Centre d’Investigation Clinique de Rennes, Rennes, France J. T. Ross, MD Department of Surgery, University of California, San Francisco, CA, USA A. Rached, MD Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France R. Garlantezec, MD, PhD Universite´ de Rennes, CHU de Rennes, Institut de recherche en sante´, environnement et travail, Rennes, France Department of Public Health and Epidemiology, Pontchaillou, University Hospital of Rennes, Rennes, France
interesting difference but, while multiple definitions of DGF have been described in the literature, the need for RRT in the first postoperative week is currently the standard.3,4 Further, although in the comparison using a creatinine-based definition of DGF the association with total saline volume was not statistically significant, the results were in the same range as in the comparison using the standard definition (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.00 to 1.29 in the logistic regression model using the standard definition of DGF vs OR, 1.12; 95% CI, 0.98 to 1.22 in the model using the creatinine-based definition). Gueret et al. also noted the relatively small difference in the total volume of normal saline given between the two groups (508 mL). While small, we believe that this is a clinically meaningful volume. Also, as the authors note, a small but significantly higher proportion of patients received gelatins or buffered crystalloids (Ringer lactate or isofundine) in the DGF group compared with the nonDGF group. Unfortunately, the volumes of these fluids were not recorded in our database, so we were not able to run additional analyses. Finally, Gueret et al. highlight the key challenge with this study, that it was not possible for us
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