Felix Guyon University Hospital, France
Nicolas VIALLET is a thirty-year-old medical doctor. He completed his medical study in Montpellier University, France. Since November 2014, he is nephrologist in Felix Guyon University Hospital, St Denis, Reunion island, France.
The RenalGuard system helps to achieve a high diuresis while simultaneously balancing urine output and venous fluid infusion to maintain euvolemia. This strategy has revealed to be beneficial to prevent contrast-induced acute kidney injury. We hypothetise it could be extended to kidney transplantation as a renoprotective action to prevent delayed graft function. The objective of our pilot study was to evaluate the feasibility and safety of RenalGuard in kidney transplant. Between december 2013 and september 2014, eleven kidney transplanted patients had a forced diuresis by Furosemide with matched hydratation by RenalGuard during the first 36 hours post transplantation (DF group). They were retrospectively compared to eleven similar patients who had spontaneous diuresis (DS group). The 11 patients of the DF group were transplanted from 7 deceased donors (4 with extended criteria) and 4 living donors. Their urine output was 265 (154-350) ml/h versus 69 (51-107) ml/h in the DS group. The diuresis quantification by RenalGuard appeared strongly correlated with the nurse measurement (R² = 0.96, p<0.001) and real-time matched hydration allowed no significant change in weight of patients. Three patients of DF group had major hyperglycemia when using glucose 5% as compensation. Hypokalemia were significantly more frequent in DF group. Use of Ringer lactate with the addition of 1g of KCl per liter should prevent the occurrence of electrolyte disturbances. There was no difference of renal function. We report for the first time the RenalGuard experience in renal transplant patients. Some precautions seem necessary in this population to prevent hyperglycemia, hypokalemia or disorders of bladder emptying.