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.
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Sense of service and pride in uniform
This ANZAC Day 2023, Australian Health Journal releases an interview with Group Captain Kath Stein MACN, Director of Defence Force Nursing with the Royal Australian Air Force.
She talks about many masks, aside from PPE, that leadership and all nurses need to wear. Currently there is work underway on a new capability description on what a nurse brings to every level in the nursing defence structure. The advice Group Captain Stein, imparts for new recruits and those interested in joining Defence Force Nursing is to take every opportunity that arises. This is evident in her progression through her career.
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Continuity of Care under COVID-19
Series 3, Episode 1
Under the COVID-19 pandemic, the Australian Healthcare system has handled the public health crisis by monitoring and responding to challenges in supply chains, testing & tracing of new infections and stock piling of essential equipment.
The public has largely responded by practising social distancing, understanding how hand hygiene can spread contagion and recently installing the COVIDSafe mobile application. Public health messaging has been largely effective and literacy improve, to combat the dangers of misinformation.
To open up access to medical advice during the pandemic, in March the Australian government issued MBS item codes for telehealth consultations, for advanced practice nurses as well as GPs and other specialists.
According to AMA President Dr Tony Bartone, as of mid-May 2020, around 10 million Medicare-funded telehealth services have been provided, either over the phone or via video, a significant majority of which have been provided by GPs and other specialists since the Medicare telehealth items were introduced in March.
However in recent months, the health system has mounting concerns on:
- a reduction in general practice visits for testing, investigation or immunisation
- lower rates of elective procedures resuming since being halted
- reduction in laboratory testing
- reduction in treatments and diagnosis of chronic and acute conditions
- access to, and continuing to take medications
Those with pre-existing conditions have been urged to keep appointments and routine treatments to maintain their health.
Industry has taken action such as the newly formed Continuity of Care Collaboration (CCC). The 15 health organisations forming CCC are an Australian first national communication collaboration of Peak Bodies, Industry and Healthcare Organisations coming together to stress the importance for people to continue monitoring their health and maintaining their regular care.
This Australian Health Journal episode on the continuity of care was produced with commentary from the following health industry associations and organisations: APNA – Australian Primary Health Care Nurses Association, RACGP, Medical Technology Association of Australia (MTAA), West Cessnock Medical Practice, Consumers Health Forum of Australia, Medicines Australia
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From University to Pharmacy Industry
The transition from full time academic study to industry can be both rewarding and challenging. Intern programs and an association for pharmacists, makes the transition easier.
The National Australian Pharmacy Students’ Association (NAPSA) represents students from 17 universities nationwide studying either an undergraduate or postgraduate program. The association advocates for Australian pharmacy students to ensure their future is prosperous and their status, rights and privileges are protected.
