Goal-directed fluid therapy in renal failure patients undergoing parathyroidectomy: a randomized, single-center, controlled trial

Abstract

Abstract Purpose: Parathyroidectomy, recommended when secondary hyperparathyroidism develops in renal failure patients on long-term renal dialysis, has high cardiovascular risks due to chronic fluid depletion. Stroke volume variation (SVV) is suitable for real-time liquid therapy titration under general anesthesia. We aimed to evaluate the Goal-directed fluid therapy by SVV for parathyroidectomy in renal failure patients. Materials and Methods: This randomized controlled trial enrolled renal failure patients (N = 121) scheduled for parathyroidectomy under general anesthesia. The Goal-directed fluid therapy (GDT) group monitor was infused with saline until SVV was under 10%; the controls received standard restricted fluid therapy (SRT). Vasoactive agents were also available to maintain systolic blood pressure (SBP)≥90mmHg, mean blood pressure (MAP)≥65mmHg, or cardiac index 2.5–4.5 (L/min/m2). Data were presented as mean or median. The primary outcome was the perioperative hemodynamic changes. The secondary outcomes were blood gas analysis, fluid supplementation, vasoactive drug dosage, operation time, dialysis parameters, postoperative complications, postoperative lactate levels, and total days of hospitalization. Results: Compared with SRT, GDT-Group patients needed more fluid, and their ephedrine use was reduced; they achieved stable blood flow changes during the perioperative period, who had lower serum lactic acid (cLAC) levels and postoperative complications. Conclusion: This is the first study to propose that goal-directed fluid therapy by SVV in renal failure patients undergoing short-term surgery under general anesthesia could correct volume depletion, optimize tissue perfusion, and reduce blood pressure fluctuations and postoperative complications, with no long-term adverse effects. Trial registration: Research Ethics Committee of Clinical Research Ethics Committee of China-Japan Friendship Hospital, Beijing, China (2018-125-K91-1). The study protocol was registered in Chinese Clinical Trial Register Network (ChiCTR1800019009, 21/10/2018).