Utility of central venous pressure measurement in renal transplantation: Is it evidence based?

Abstract

Adequate intravenous fluid therapy is essential in renal transplant recipients to ensure a good allograft perfusion. Central venous pressure (CVP) has been considered the cornerstone to guide the fluid therapy for decades; it was the only available simple tool worldwide. However, the revolutionary advances in assessing the dynamic preload variables together with the availability of new equipment to precisely measure the effect of intravenous fluids on the cardiac output had created a question mark on the future role of CVP. Despite the critical role of fluid therapy in the field of transplantation. There are only a few clinical studies that compared the CVP guided fluid therapy with the other modern techniques and their relation to the outcome in renal transplantation. Our work sheds some light on the available published data in renal transplantation, together with data from other disciplines evaluating the utility of central venous pressure measurement. Although lager well-designed studies are still required to consolidate the role of new techniques in the field of renal transplantation, we can confidently declare that the new techniques have the advantages of providing more accurate haemodynamic assessment, which results in a better patient outcome.

Keywords: Central venous pressure; Fluid monitoring; Renal transplantation.

Figure 1

Monitoring parameters used by intensive care unit physicians[6]. BP: Intra-arterial blood pressure; CVP: Central venous pressure; CVP oxy: Continuous monitoring of central venous oxygen saturation; Foley: Foley catheter; O2 sat: Oxygen saturation; PAC: Pulmonary artery catheter; Telem: Telemetry.

Figure 2

Volume resuscitation end-points[6]. BP: Blood pressure; CO: Cardiac output; CVP: Central venous pressure; CVP rise: Sustained rise in central venous pressure; HR: Heart rate; MvO2: Mixed venous oxygen saturation; Per Perf: Peripheral perfusion; ScvO2: Central venous oxygen saturation; UO: Urine output.