Pulse pressure variation versus central venous pressure guided fluid management therapy in kidney transplant recipients: A single-blinded prospective randomized control study.

Background: End-stage renal disease (ESRD) necessitates renal transplantation, where precise fluid management is essential for graft perfusion and function. Central venous pressure (CVP) is traditionally used, but the optimal strategy is uncertain. Pulse pressure variation (PPV), a dynamic index, may better predict fluid responsiveness. This randomized trial compared PPV- versus CVP-guided fluid therapy in kidney transplant recipients. Methods: Fifty ESRD patients undergoing renal transplantation were randomly divided into two groups (n = 25 each). Group A received intraoperative fluid therapy guided by PPV, while Group B followed CVP-guided fluid therapy. The primary outcome was total intraoperative fluid administered. Secondary outcomes included total urine output, time to onset of diuresis, incidence of hypotensive episodes, and post-reperfusion lactate levels. Data were analyzed with independent t-tests or Mann-Whitney tests for continuous variables and Fisher's exact test for categorical variables; Results: Total fluid administration was significantly lower in the PPV group (1862 ± 327 mL) than in the CVP group (2480 ± 355 mL; Conclusion: PPV-guided therapy reduced fluid requirements and accelerated diuresis without increasing hypotension or lactate levels, supporting dynamic over static preload indices for optimizing graft perfusion.