Schutter, R. (Rianne) (2012) The correlation between the hemodynamic parameters blood pressure, mean arterial pressure, cardiac index and systemic vascular resistance on serum creatinine in recipients of living donor kidney transplantation. thesis, Medicine.
Full text available on request.Abstract
Background: For patients with end-stage renal disease, kidney transplantation is proven to be the best treatment. Within the field of anaesthesiology, hemodynamic parameters are expected to have an impact on the graft function of the transplanted kidney. It is well known that an adequate intra vascular volume is an important indicator for immediate graft function (IGF).17,18 However, intra vascular volume is related to several hemodynamic parameters and it is still relatively uncertain which of those represents best the hemodynamic condition of the patient and the micro circulation of the renal graft. Moreover, in literature most studies contain patient populations in the field of post mortal donors, so even less is known about the hemodynamic state in living donor kidney transplantation (LDKT). This leads to our research question: Is there a correlation between hemodynamic parameters (systolic, diastolic and mean arterial pressure, systemic vascular resistance and cardiac index) and the serum creatinine in the recipient of living donor kidney transplantation? Materials and methods: The study design is an observational prospective cohort pilot. Only patients from the age of 18 were included. Exclusion criteria were right kidney transplantation, a body mass index (BMI) of ≤ 17 or ≥ 35, neurological conditions, altruistic donors and participation in the ABO-incompatible program. In total 23 patients were included. Hemodynamic parameters (systolic, diastolic en mean arterial pressure, systemic vascular resistance and cardiac index) were measured with the PiCCO catheter and a central venous line. Renal function after transplantation was assessed by the serum creatinine. The quantification of the creatinine decline was calculated by 3 different quantification methods (absolute difference, area above the curve and logarithmic decline gradient) over 3 and 9 post-operative days. The investigated hemodynamic time points were: pre-operative, 30 seconds after start reperfusion, 10 minutes after start reperfusion, the average of the entire procedure and the lowest measured value during the entire procedure. Correlation was calculated with Spearman’s correlation coefficient and p<0.05 was considered to be statistically significant. Results: The mean value of serum creatinine before transplantation was 558 μmol/L and 141 μmol/L 9 days after surgery. Regarding 9 days post-operative, the average intra-operative diastolic blood pressure shows a correlation coefficient with a p value of <0,01 in all methods for the quantification of the creatinine. Also the average intra-operative MAP shows significant results among 2 out of 3 methods, with a p value of 0,035 and 0,009. With regard to 3 days post-operative, results show correlation coefficients with significant p values for the average diastolic blood pressure, with p=0,002, p=0,022 and p=0,001. Also the SVR measured 30 seconds after the start of reperfusion shows correlation coefficients with significant p values, with all 3 methods p<0,05. Conclusion: This study shows a correlation between the serum creatinine decline until the 9th postoperative day and the average intra-operative diastolic pressure as well as with the mean arterial pressure. When looking to the serum creatinine decline until the 3rd post-operative day, a correlation is found with the average intra-operative diastolic pressure and the systemic vascular resistance at the moment of 30 seconds after the start of reperfusion
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Moeke, Drs. G.J. anaesthesiologist and Department of anaesthesiology and University Medical Centre Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/324 |
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