Background: End-stage renal disease (ESRD) necessitates renal transplantation, where precise fluid management is essential for graft perfusion and function. Central venous pressure (CVP) is traditionally used, but the optimal strategy is uncertain. Pulse pressure variation (PPV), a dynamic index, may better predict fluid responsiveness. This randomized trial compared PPV- versus CVP-guided fluid therapy in kidney transplant recipients. Methods: Fifty ESRD patients undergoing renal transplantation were randomly divided into two groups (n = 25 each). Group A received intraoperative fluid therapy guided by PPV, while Group B followed CVP-guided fluid therapy. The primary outcome was total intraoperative fluid administered. Secondary outcomes included total urine output, time to onset of diuresis, incidence of hypotensive episodes, and post-reperfusion lactate levels. Data were analyzed with independent t-tests or Mann–Whitney tests for continuous variables and Fisher’s exact test for categorical variables; P < 0.05 denoted significance. Results: Total fluid administration was significantly lower in the PPV group (1862 ± 327 mL) than in the CVP group (2480 ± 355 mL; P < 0.0001). Intraoperative urine output was higher with PPV guidance (996 ± 348 mL vs. 820 ± 141 mL; P = 0.026). The time to diuresis was shorter in the PPV group (median 1 min IQR 1–2 vs. 2 min IQR 1–3; P = 0.0008). Incidence of hypotension and lactate levels post clamp release did not differ between groups. Conclusion: PPV-guided therapy reduced fluid requirements and accelerated diuresis without increasing hypotension or lactate levels, supporting dynamic over static preload indices for optimizing graft perfusion.
Gupta et al. (Wed,) studied this question.