A world-first clinical trial conducted at the Royal Adelaide Hospital (RAH) and at hospitals across Australia and New Zealand has identified the best fluid treatment to reduce the risk of patients requiring dialysis after a kidney transplant.
Around one in three people who receive a kidney transplant suffer delayed graft function, which means the transplant doesn’t work immediately and they require dialysis.
To reduce the risk of this occurring, patients are given up to eight litres of IV fluid in the first two days after a kidney transplant.
The BEST Fluids trial compared the use of two intravenous (IV) fluids, Plasma-Lyte 148 and saline, finding Plasma-Lyte 148 reduces the need for dialysis by 25 per cent.
Australian Health Journal spoke with the lead-author of the study, RAH Nephrologist and University of Adelaide researcher, Dr Michael Collins.
Dr Collins provided background by stating, “While both types of fluids have been used during kidney transplantation in recent years, until now there had been little robust evidence to demonstrate which one was the most effective and safest to use.”
During the four-year study, these fluids were trialled in 808 patients with kidney failure, who received a kidney transplant from a deceased organ donor at the RAH and 15 other hospitals in Australia and New Zealand.
Saline is the most common type of IV fluid and contains salt (sodium chloride) and water and has been the standard treatment in kidney transplantation. Plasmalyte 148 is a balanced crystalloid fluid containing a mixture of salts, which more closely resembles what is in human blood.
Researchers at the University of Adelaide and University of Sydney, working with the Australasian Kidney Trials Network team and the ANZDATA Registry at the South Australian Health and Medical Research Institute (SAHMRI), found 30 per cent of participants who received Plasma-Lyte 148 needed dialysis after transplant, compared with 40 per cent of participants who received saline.
Commenting on the findings and potential impact to clinical care, Dr Collins said, “Our finding of a substantial reduction in dialysis with balanced crystalloid compared with saline, without any increase in complications or side effects, provides a strong justification to change clinical practice.”
Using Plasma-Lyte 148 did not result in more complications or side effects compared to saline. At one year after the transplant, both groups had similar levels of kidney function while rates of death, rejection and loss of kidney transplant function were also similar for both groups.
The results of the study are now being used to improve the health of kidney transplant patients in Australia and New Zealand and it is likely that practice will change at transplant units around the world.
Dr Collins added, “Balanced fluids are relatively cheap and widely available, so we hope this practise can now be used for most of the estimated 200,000 kidney transplant operations conducted across the globe each year.”
The BEST Fluids trial was funded by the National Health and Medical Research Council (NHMRC) administered Medical Research Future Fund (MRFF) Australia, the Health Research Council of New Zealand, and the Royal Australasian College of Physicians, with trial fluids supplied by Baxter Australia and New Zealand. The results of the study have been published in The Lancet.
-
More health care volunteers needed for Street Side Medics
Identifying a gap in the healthcare of vulnerable people in New South Wales, Dr Daniel Nour founded Street Side Medics in August 2020, a not-for-profit, GP-led mobile medical service for people experiencing homelessness.
Dr. Daniel Nour is a cardiology advanced trainee at Royal North Shore Hospital and the founder of Street Side Medics, a mobile medical service dedicated to providing GP-led care to individuals experiencing homelessness. The initiative started from a customised van, which serves as a medical clinic, visiting food services and shelters across New South Wales and recently Victoria. Street Side Medics offers free medical care without requiring documentation, ID, or a Medicare card.
-
Surgical Site Infection (SSI) Synopsis, including modifiable and non-modifiable risk factors
Talking to the Australian Health Journal, Professor Russo states there is a particular concern in joint operations, such as hip or knee replacements, as infections in these areas can have severe consequences, including the removal of the infected joint, prolonged treatment, and significant costs for both hospitals and patients. Despite the substantial impact of surgical site infections, Australia lacks a national surveillance program for these infections, making it challenging to obtain accurate data. However, an estimate suggests that around 45,000 surgical site infections occur annually in Australia, resulting in approximately 900 deaths.
-
Dental and oral health care priorities for the elderly
In 2023, there are a number of changes occurring in dental services including the start of a new Senate inquiry and new registered nurses in residential aged care. Yet in the meantime there are gaps and delays in dental and oral health interventions for elderly Australians, unless training is more widely deployed.
Australian Health Journal spoke to Leonie Short, a dental therapist working for Seniors Dental Care Australia on what she considers are dental and oral health priorities for the elderly, based on her work in the aged, home and disability sectors.
