Deficiency of Actual Bicarbonate as a Risk Factor for Delayed Kidney Transplant Function from a Living -Related Donor

Introduction. Kidney transplant recipients are patients with the terminal stage of chronic kidney disease having an initially unfavorable metabolic status, such as hypoplastic anemia, uremic endotoxemia, disturbances in water-electrolyte and acid-base balance. A number of epidemiological studies have shown a link between low serum bicarbonate levels and unfavorable renal outcomes and patient mortality. Aim of research was to study acid-base balance disorders in 246 recipients of living related kidney transplantation and its link with the development of delayed transplant function, based on which to establish threshold values of the most informative indicators of acid-base balance, the excess of which was associated with the risk of developing this condition. Material and methods. The study included 246 recipients of related kidney transplants from a living donor operated at the State Institute “Republican Specialized Scientific-Practical Medical Center of Surgery named after academician V.Vakhidov” from 2010 to 2020. Parameters of pO2, pCO2, HCO3, BE, pH, lactate, hemoglobin, and deep oxygen status (p50) were determined in arterial blood taken in a PICO-70 heparinized syringe using an ABL 800 device (Radiometer, USA). Results. Estimation of the transplant function by the level of creatinine reduction in blood serum of kidney transplant recipients showed that 24 hours after the surgery, the primary functioning transplant occurred in 190 (77.2%) patients, delayed transplant function was in 51 (20.8%) patients, transplant dysfunction - in 5 (2.0%) patients (in 2 (0.8%) of them - due to acute rejection). It was found that determination of HCO3 level and creatinine immediately before surgery is informative to predict the risk of delayed transplant function. A decrease of the actual bicarbonate level of less than 19.8 mmol / l, creatinine of more than 927 μmol / l are risk factors for delayed transplant functioning 24 hours after surgery. Conclusion. Kidney transplantation recipients - patients with terminal stage of CKD - immediately before surgery have compensated MA (actual bicarbonate increase and BE), an increase of pO2 and p50 which indicates a deficiency in the metabolic component of ABB regulation and hyperoxia. It is informative to determine the level of aHCO3, creatinine immediately before surgery to predict the risk of delayed transplant function. A decrease in the actual bicarbonate of less than 19.8 mmol / l, creatinine of more than 927 μmol /l are risk factors for delayed graft functioning 24 hours after surgery.