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01-09-2009 | Original

Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients

Authors: Franziska Schabinski, Janaina Oishi, Fabio Tuche, Alain Luy, Yasser Sakr, Donald Bredle, Christiane Hartog, Konrad Reinhart

Published in: Intensive Care Medicine | Issue 9/2009

Abstract

Purpose

To compare the effects of predominantly hydroxyethyl starch (HES 6% 130/0.4)-based with predominantly gelatin 4%-based fluid therapy on renal function in surgical intensive care unit (ICU) patients.

Methods

Before–after, retrospective, study of surgical ICU patients. All patients admitted from January to June 2005 formed the HES group, with HES 130/0.4 as the standard colloid of choice. All patients admitted from January to June 2006 formed the GEL group, with gelatin 4% as the primary colloid. Acute renal failure (ARF) was defined as new need for renal replacement therapy (RRT) or at least a two-fold increase in baseline creatinine.

Results

There were 1383 patients in the HES group and 1528 in the GEL group; 118 and 87, in each group respectively, had severe sepsis. The incidence of ARF and ICU and hospital mortality rates were similar in the two groups. In a post-hoc multivariable analysis, cumulative doses >33 ml/kg of either HES (OR = 1.85, 95% CI: 1.01–3.41, p < 0.001) or gelatin (OR = 1.99, 95% CI: 1.05–3.79, p = 0.035) were associated with a higher risk of ARF.

Conclusions

The incidence of ARF was similar in patients who received predominantly HES (6% 130/.04) fluid therapy and in those who received predominantly gelatin 4%. Moderate cumulative doses of modern HES or gelatin solutions may be associated with a higher risk of ARF.

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Sakr Y, Payen D, Reinhart K, Sipmann FS, Zavala E, Bewley J, Marx G, Vincent JL (2007) Effects of hydroxyethyl starch administration on renal function in critically ill patients. Br J Anaesth 98:216–224PubMedCrossRef

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256PubMedCrossRef

Brunkhorst FM (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139PubMedCrossRef

Treib J, Baron JF, Grauer MT, Strauss RG (1999) An international view of hydroxyethyl starches. Intensive Care Med 25:258–268PubMedCrossRef

Hoffmann JN, Vollmar B, Laschke MW, Inthorn D, Schildberg FW, Menger MD (2002) Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia. Anesthesiology 97:460–470PubMedCrossRef

Morisaki H, Bloos F, Keys J, Martin C, Neal A, Sibbald WJ (1994) Compared with crystalloid, colloid therapy slows progression of extrapulmonary tissue injury in septic sheep. J Appl Physiol 77:1507–1518PubMed

Mishler JM (1984) Synthetic plasma volume expanders—their pharmacology, safety and clinical efficacy. Clin Haematol 13:75–92PubMed

Barron ME, Wilkes MM, Navickis RJ (2004) A systematic review of the comparative safety of colloids. Arch Surg 139:552–563PubMedCrossRef

Haskell LP, Tannenberg AM (1988) Elevated urinary specific gravity in acute oliguric renal failure due to hetastarch administration. N Y State J Med 88:387–388PubMed

10.

Waldhausen P, Kiesewetter H, Leipnitz G, Scielny J, Jung F, Bambauer R, von Blohn G (1991) Hydroxyethyl starch-induced transient renal failure in preexisting glomerular damage. Acta Med Austriaca 18(Suppl 1):52–55PubMed

11.

Dickenmann MJ, Filipovic M, Schneider MC, Brunner FP (1998) Hydroxyethylstarch-associated transient acute renal failure after epidural anaesthesia for labour analgesia and caesarean section. Nephrol Dial Transplant 13:2706CrossRef

12.

De Labarthe A, Jacobs F, Blot F, Glotz D (2001) Acute renal failure secondary to hydroxyethylstarch administration in a surgical patient. Am J Med 111:417–418PubMedCrossRef

13.

Winkelmayer WC, Glynn RJ, Levin R, Avorn J (2003) Hydroxyethyl starch and change in renal function in patients undergoing coronary artery bypass graft surgery. Kidney Int 64:1046–1049PubMedCrossRef

14.

Legendre C, Thervet E, Page B, Percheron A, Noel LH, Kreis H (1993) Hydroxyethylstarch and osmotic-nephrosis-like lesions in kidney transplantation. Lancet 342:248–249PubMedCrossRef

15.

Cittanova ML, Leblanc I, Legendre C, Mouquet C, Riou B, Coriat P (1996) Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet 348:1620–1622PubMedCrossRef

16.

Deman A, Peeters P, Sennesael J (1999) Hydroxyethyl starch does not impair immediate renal function in kidney transplant recipients: a retrospective, multicentre analysis. Nephrol Dial Transplant 14:1517–1520PubMedCrossRef

17.

Kumle B, Boldt J, Piper S, Schmidt C, Suttner S, Salopek S (1999) The influence of different intravascular volume replacement regimens on renal function in the elderly. Anesth Analg 89:1124–1130PubMedCrossRef

18.

Boldt J, Brenner T, Lehmann A, Lang J, Kumle B, Werling C (2003) Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin. Intensive Care Med 29:763–769PubMed

19.

Schortgen F, Brochard L, Burnham E, Martin GS (2003) Pro/con clinical debate: hydroxyethylstarches should be avoided in septic patients. Crit Care 7:279–281PubMedCrossRef

20.

Schildt B, Bouveng R, Sollenberg M (1975) Plasma substitute induced impairment of the reticuloendothelial system function. Acta Chir Scand 141:7–13PubMed

21.

Walley KR, McDonald TE, Wang Y, Dai S, Russell JA (2003) Albumin resuscitation increases cardiomyocyte contractility and decreases nitric oxide synthase II expression in rat endotoxemia. Crit Care Med 31:187–194PubMedCrossRef

22.

Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire F, Brochard L (2001) Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 357:911–916PubMedCrossRef

23.

Suttner S, Boldt J (2004) Volume replacement with hydroxyethyl starch: is there an influence on kidney function? Anasthesiol Intensivmed Notfallmed Schmerzther 39:71–77PubMedCrossRef

24.

Muller L, Jaber S, Lefrant JY (2008) Insulin and pentastarch for severe sepsis. N Engl J Med 358:2072–2073PubMed

25.

Jungheinrich C, Scharpf R, Wargenau M, Bepperling F, Baron JF (2002) The pharmacokinetics and tolerability of an intravenous infusion of the new hydroxyethyl starch 130/0.4 (6%, 500 mL) in mild-to-severe renal impairment. Anesth Analg 95:544–551

26.

FDA Center for Biologics Evaluation and ResearchNDA Review memo (mid-cycle) Available at: http://www.fda.gov/Cber/nda/voluven/voluvenmidmem.pdf. Accessed on September 3 2008

27.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

28.

Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med 26:1793–1800PubMed

29.

American College of Chest Physicians/Society of Critical Care Medicine (1992) Consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874CrossRef

30.

Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM (2004) Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 30:536–555PubMedCrossRef

31.

Reinhart K, Brunkhorst F, Bone H, Gerlach H, Grundling M, Kreymann G, Kujath P, Marggraf G, Mayer K, Meier-Hellmann A, Peckelsen C, Putensen C, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Werdan K (2006) Diagnosis and therapy of sepsis: guidelines of the German Sepsis Society Inc. and the German Interdisciplinary Society for Intensive and Emergency Medicine. Anaesthesist 55(Suppl 1):43–56PubMed

32.

Hussain SF, Drew PJ (1989) Acute renal failure after infusion of gelatins. BMJ 299:1137–1138PubMedCrossRef

33.

Stockwell MA, Scott A, Day A, Riley B, Soni N (1992) Colloid solutions in the critically ill. A randomised comparison of albumin and polygeline 2. Serum albumin concentration and incidences of pulmonary oedema and acute renal failure. Anaesthesia 47:7–9PubMedCrossRef

34.

Trull A, Hughes V, Cooper D, Wilkins M, Gimson A, Friend P, Johnston A, Sharples L, Park G (2002) Influence of albumin supplementation on tacrolimus and cyclosporine therapy early after liver transplantation. Liver Transpl 8:224–232PubMedCrossRef

35.

Boldt J, Brosch C, Rohm K, Papsdorf M, Mengistu A (2008) Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients. Br J Anaesth 100:457–464PubMedCrossRef

36.

Mahmood A, Gosling P, Vohra RK (2007) Randomized clinical trial comparing the effects on renal function of hydroxyethyl starch or gelatine during aortic aneurysm surgery. Br J Surg 94:427–433PubMedCrossRef

37.

Boldt J, Brosch C, Ducke M, Papsdorf M, Lehmann A (2007) Influence of volume therapy with a modern hydroxyethylstarch preparation on kidney function in cardiac surgery patients with compromised renal function: a comparison with human albumin. Crit Care Med 35:2740–2746PubMedCrossRef

38.

Wiesen P, Canivet JL, Ledoux D, Roediger L, Damas P (2005) Effect of hydroxyethylstarch on renal function in cardiac surgery: a large scale retrospective study. Acta Anaesthesiol Belg 56:257–263PubMed

39.

Liet JM, Bellouin AS, Boscher C, Lejus C, Roze JC (2003) Plasma volume expansion by medium molecular weight hydroxyethyl starch in neonates: a pilot study. Pediatr Crit Care Med 4:305–307PubMedCrossRef

40.

Beyer R, Harmening U, Rittmeyer O, Zielmann S, Mielck F, Kazmaier S, Kettler D (1997) Use of modified fluid gelatin and hydroxyethyl starch for colloidal volume replacement in major orthopaedic surgery. Br J Anaesth 78:44–50PubMed

41.

Vogt N, Bothner U, Brinkmann A, de Petriconi R, Georgieff M (1999) Peri-operative tolerance to large-dose 6% HES 200/0.5 in major urological procedures compared with 5% human albumin. Anaesthesia 54:121–127PubMedCrossRef

42.

Arellano R, Gan BS, Salpeter MJ, Yeo E, McCluskey S, Pinto R, Irish J, Ross DC, Doyle DJ, Parkin J, Brown D, Rotstein L, Witterick I, Matthews W, Yoo J, Neligan PC, Gullane P, Lampe H (2005) A triple-blinded randomized trial comparing the hemostatic effects of large-dose 10% hydroxyethyl starch 264/0.45 versus 5% albumin during major reconstructive surgery. Anesth Analg 100:1846–1853PubMedCrossRef

43.

Schortgen F, Girou E, Deye N, Brochard L (2008) The risk associated with hyperoncotic colloids in patients with shock. Intensive Care Med 34:2157–2168PubMedCrossRef

44.

Wiedermann CJ (2008) Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis. BMC Emerg Med 8:1PubMedCrossRef

45.

Haynes GR, Havidich JE, Payne KJ (2004) Why the food and drug administration changed the warning label for hetastarch. Anesthesiology 101:560–561PubMedCrossRef

46.

Wilkes MM, Navickis RJ, Sibbald WJ (2001) Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg 72:527–533PubMedCrossRef

Title: Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients
Authors: Franziska Schabinski
Janaina Oishi
Fabio Tuche
Alain Luy
Yasser Sakr
Donald Bredle
Christiane Hartog
Konrad Reinhart
Publication date: 01-09-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 9/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1509-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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