Association of high volumes of hydroxyethyl starch with acute kidney injury in elderly trauma patients

Leberle, Richard; Ernstberger, Antonio; Loibl, Markus; Merkl, J.; Bunz, Maxie; Creutzenberg, Marcus; Trabold, Benedikt

doi:10.1016/j.injury.2014.08.039

Cited by 14 publications

(10 citation statements)

References 33 publications

(29 reference statements)

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“…Our data also shows that that the adverse effects of synthetic colloids on renal function and coagulation did not differ between age groups, in contrast to findings of previous smaller studies 7 , 10 – 13 . Furthermore, synthetic colloid use decreased continuously since 2008, and this decrease was associated with a parallel decrease in overall fluid intake.…”

Section: Discussioncontrasting

confidence: 77%

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Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Hilbert-Carius

Schwarzkopf

Reinhart

et al. 2018

Sci Rep

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The purpose of this study was to investigate the efficacy and safety of synthetic colloid resuscitation among severely injured patients. Fluid resuscitation of trauma patients of a nationwide trauma registry was analysed between 2002 and 2015. Effects of synthetic colloid resuscitation in the pre-hospital setting and emergency department on renal failure, renal replacement therapy and multiple organ failure were analysed among patients with ≥2 days intensive care unit stay, and in-hospital mortality was analysed among all patients. 48,484 patients with mean age of 49 years and mean injury severity score of 23 points were included; 72.3% were male and 95.5% had blunt trauma. Risk-adjusted analyses revealed that patients receiving >1,000 ml synthetic colloids experienced an increase of renal failure and renal replacement therapy rates (OR 1.42 and 1.32, respectively, both p ≤ 0.006). Any synthetic colloid use was associated with an increased risk of multiple organ failure (p < 0.001), but there was no effect on hospital mortality (p = 0.594). Between 2002 and 2015 usage of synthetic colloids dropped, likewise did total fluid intake and usage of blood products. The data from this analysis suggests that synthetic colloid resuscitation provides no beneficial effects and might be harmful in patients with severe trauma.

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Section: Discussioncontrasting

confidence: 77%

“…Increased incidence of kidney injury was also observed in other smaller trauma cohort studies 12 , 13 and in a large observational study of patients receiving non-cardiac surgery 19 . A meta-analysis on the impact of HES 130/04 on the need for renal replacement therapy identified an increased risk in surgical patients 20 .…”

Section: Discussionsupporting

confidence: 72%

Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Hilbert-Carius

Schwarzkopf

Reinhart

et al. 2018

Sci Rep

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show abstract

“…This meta-analysis showed that HES significantly increased the length of ICU stay. Many studies [ 40 - 42 ] reported the same result on the length of hospital stay between the HES group and other solution groups, but we found no related report on the length of ICU stay in adult patients. Given the limited number of studies enrolled in this meta-analysis, more clinical studies with larger sample sizes are needed to confirm the association between HES use and the length of ICU stay.…”

Section: Discussioncontrasting

confidence: 53%

Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials

et al. 2015

Crit Care

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IntroductionHydroxyethyl starch (HES) has been widely used for volume expansion, but its safety in adult patients has been questioned recently. The aim of this meta-analysis is to see whether or not HES has any adverse effect in pediatric patients.MethodsRandomized controlled trials (RCTs) involving pediatric patients who received 6% low-molecular-weight HES, published before January 2014, were searched for in Pubmed, Embase database and Cochrane Library. Two reviewers independently extracted the valid data, including the mortality, renal function, coagulation, blood loss, hemodynamic changes, and length of hospital and ICU stay. All data were analyzed by I2-test, and the results of statistical analysis were displayed in forest plots. Possible publication bias was tested by funnel plots. Bayesian analysis was performed using WinBUGS with fixed and random effects models.ResultsA total of 13 RCTs involving 1,156 pediatric patients were finally included in this meta-analysis. Compared with other fluids, HES did not significantly decrease the mortality (RR = -0.01; 95%CI: 0.05 to 0.03; P = 0.54; I2 = 6%), creatinine level (I2-test: MD = 1.81; 95%CI: -0.35 to 3.98; P = 0.10;I2 = 0%; Bayesian analysis: Fixed effect model MD = 1.77; 95%CI: -0.07 to 3.6; Random effects model MD = 1.78; 95%CI: -1.86 to 5.33), activated partial thromboplastin time (MD = 0.01; 95%CI: -1.05 to 1.07; P = 0.99; I2 = 42%), and blood loss (MD = 17.72; 95%CI: -41.27 to 5.82; P = 0.10; I2 = 0%) in pediatric patients. However, HES significantly decreased the blood platelet count (MD = 20.99; 95%CI: -32.08 to -9.90; P = 0.0002; I2 = 28%) and increased the length of ICU stay (MD = 0.94; 95%CI: 0.18 to 1.70; P = 0.02; I2 = 46%).ConclusionsVolume expansion with 6% HES significantly decreased the platelet count and increased the length of ICU stay, also might have an adverse effect on renal function. Therefore HES is not recommended for pediatric patients, which safety needs more high quality RCTs and studies to confirm in future.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0815-y) contains supplementary material, which is available to authorized users.

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“…Yet, owing to the lack of hard outcome parameters in this study (e.g., mortality), future clinical trials are certainly needed to address this point. However, the increased frequency of renal replacement therapy associated with the use of colloids has been shown only for fluid resuscitation in critically ill patients with sepsis, and it could not be demonstrated for perioperative or trauma patients [ 55 , 56 ]. Causative approaches to explaining these findings remain scarce.…”

Section: Discussionmentioning

confidence: 99%

6% Hydroxyethyl starch (HES 130/0.4) diminishes glycocalyx degradation and decreases vascular permeability during systemic and pulmonary inflammation in mice

et al. 2018

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BackgroundIncreased vascular permeability is a pathophysiological hallmark of sepsis and results in increased transcapillary leakage of plasma fluid, hypovolemia, and interstitial edema formation. 6% hydroxyethyl starch (HES 130/0.4) is commonly used to treat hypovolemia to maintain adequate organ perfusion and oxygen delivery. The present study was designed to investigate the effects of 6% HES 130/0.4 on glycocalyx integrity and vascular permeability in lipopolysaccharide (LPS)-induced pulmonary inflammation and systemic inflammation in mice.Methods6% HES 130/0.4 or a balanced electrolyte solution (20 ml/kg) was administered intravenously 1 h after cecal ligation and puncture (CLP) or LPS inhalation. Sham-treated animals receiving 6% HES 130/0.4 or the electrolyte solution served as controls. The thickness of the endovascular glycocalyx was visualized by intravital microscopy in lung (LPS inhalation model) or cremaster muscle (CLP model). Syndecan-1, hyaluronic acid, and heparanase levels were measured in blood samples. Vascular permeability in the lungs, liver, kidney, and brain was measured by Evans blue extravasation.ResultsBoth CLP induction and LPS inhalation resulted in increased vascular permeability in the lung, liver, kidney, and brain. 6% HES 130/0.4 infusion led to significantly reduced plasma levels of syndecan-1, heparanase, and hyaluronic acid, which was accompanied by a preservation of the glycocalyx thickness in postcapillary venules of the cremaster (0.78 ± 0.09 μm vs. 1.39 ± 0.10 μm) and lung capillaries (0.81 ± 0.09 μm vs. 1.49 ± 0.12 μm).ConclusionsThese data suggest that 6% HES 130/0.4 exerts protective effects on glycocalyx integrity and attenuates the increase of vascular permeability during systemic inflammation.Electronic supplementary materialThe online version of this article (doi: 10.1186/s13054-017-1846-3) contains supplementary material, which is available to authorized users.

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Association of high volumes of hydroxyethyl starch with acute kidney injury in elderly trauma patients

Cited by 14 publications

References 33 publications

Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Safety evaluation on low-molecular-weight hydroxyethyl starch for volume expansion therapy in pediatric patients: a meta-analysis of randomized controlled trials

6% Hydroxyethyl starch (HES 130/0.4) diminishes glycocalyx degradation and decreases vascular permeability during systemic and pulmonary inflammation in mice

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