Fluid Therapy With Gelatin May Have Deleterious Effects on Kidney Function: An Observational Trial

Heringlake, Matthias; Berggreen, Astrid Ellen; Reemts, Enno; Schemke, Simon; Balzer, Felix; Charitos, Efstratios I.; Bucsky, B.; Paarmann, Hauke; Schmidt, Christian

doi:10.1053/j.jvca.2020.03.037

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…The highest uKIM-1 level 24 h after surgery was observed in group A, where the highest volume of the 3% gelatin solution had been administered (23.3 [19.7 ÷ 25.0] mL/kg). The results are consistent with the available literature reports 32 .…”

Section: Discussionsupporting

confidence: 93%

Effect of a 3% gelatin solution on urinary KIM-1 levels in patients after thyroidectomy: a preliminary randomized controlled trial

Leśnik

Woźnica-Niesobska

Janc

et al. 2021

Sci Rep

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Optimal fluid therapy significantly affects the maintenance of proper tissue perfusion and, consequently, kidney function. An adverse effect of colloids on kidney function is related to the incidence of postoperative kidney failure. The study aimed to assess the effect of a 3% gelatin solution on kidney function based on the urinary kidney injury molecule-1 (uKIM-1) level. This study used a parallel design and enrolled 64 adult patients with a mean age of 52.5 ± 13.1 years, all of whom underwent a thyroidectomy procedure under general anesthesia. Patients were randomly assigned to three comparison groups, each receiving a different dose of 3% gelatin solution during the thyroidectomy procedure. The patients from study groups A (n = 21) and B (n = 21) received a 3% gelatin solution at a dose of 30 ml/kg and 15 ml/kg body weight, respectively, during the first hour of the procedure. The patients from the control group C (n = 22) received an isotonic multi-electrolyte solution. Serum creatinine levels were determined, and urine samples were collected to determine levels of uKIM-1 before, 2 h, and 24 h after surgery. The patients’ demographic data, type and volume of fluid and hemodynamic status during the surgery were collected from relevant anesthesia protocols and were included in the study data. There were no statistically significant changes between groups in hemodynamic parameters such as systolic and diastolic blood pressure, heart rate, and oxygen saturation values. A statistically significant increase in uKIM-1 level was noted in patients receiving the 3% gelatin solution regardless of the dose. A statistically significant difference in uKIM-1 level was observed between groups A, B, and C measured 24 h after surgery, with the highest uKIM-1 level in group A. Measurement of uKIM-1 level could be an early and sensitive biomarker of kidney injury. Kidney toxicity of a 3% gelatin solution, evaluated based on the level of uKIM-1 in urine, correlates with transfused fluid volume. This study was retrospectively registered in the ISRCTN clinical trials registry (ISRCTN73266049, 08/04/2021: https://www.isrctn.com/ISRCTN73266049).

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Section: Discussionsupporting

confidence: 93%

Effect of a 3% gelatin solution on urinary KIM-1 levels in patients after thyroidectomy: a preliminary randomized controlled trial

Leśnik

Woźnica-Niesobska

Janc

et al. 2021

Sci Rep

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“…Allerdings wurde in der Regel das 3-fache Volumen Gelatine im Vergleich zu HES gegeben. Von den Autoren konnte ein Einfluss dieser Dysbalance nicht sicher ausgeschlossen werden, sodass diese Ergebnisse dringend überprüft werden müssen [13]. In die gleiche Richtung deutende Ergebnisse zeigt ein Tiermodell des hämorrhagischen Schocks.…”

Section: Akute Intraoperative Blutungunclassified

Flüssigkeits- und Volumentherapie mit kristalloiden und kolloidalen Lösungen

Jedlička¹,

Jacob²,

Chappell³

2021

Anästhesiol Intensivmed Notfallmed Schmerzther

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“…5,6 However, previously colloids have been studied in septic and acutely ill patients in the intensive care unit (ICU), 7,8 and they may be a risk factor for acute kidney injury (AKI) also in cardiac surgery. 9,10 Between 5% and 30% of patients develop cardiac surgery-related AKI. 1,2,11,12 Even a mild degree of AKI is associated independently with mortality and morbidity after cardiac 1,2,13,14 and non-cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Gelatin and the risk of acute kidney injury after cardiac surgery

Koponen

Musialowicz

Lahtinen

2021

Acta Anaesthesiol Scand

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Background: Gelatin has been used as a plasma volume expander because of its ability to preserve intravascular volume more effectively than crystalloids. However, gelatin may have detrimental effects on kidney function and increase the risk of acute kidney injury (AKI). Method:We investigated by retrospective analysis of prospectively collected data whether the administration of 4% succinyl gelatin is associated with an increased risk of AKI after cardiac surgery. We compared two propensity score-matched groups of 1,187 patients (crystalloid group and gelatin group). Results:The incidence of AKI was similar in both groups (gelatin 21% and crystalloid 20%) (p = 0.414). The incidence of moderate AKI (8% vs. 6%) was higher in the gelatin group, but there was no difference in mild or severe AKI. Postoperative serum creatine on the first (70 vs. 70 μmol L −1 , p = 0.689) or fourth (71 vs. 70, p = 0.313) postoperative day was similar between groups and there was no difference in the need for new renal replacement therapy (p = 0.999). Patients in the gelatin group received less crystalloids (2080 ml vs. 4130 ml, p = 0.001) and total fluids (3760 ml vs. 4180 ml, p = 0.001), their fluid balance was less positive (p = 0.001) and they required less vasoactive and inotropic medication (p = 0.001). Gelatin was not associated with increased mortality compared to the crystalloid group. Conclusion:Gelatin was not associated with AKI after cardiac surgery.

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Fluid Therapy With Gelatin May Have Deleterious Effects on Kidney Function: An Observational Trial

Cited by 12 publications

References 24 publications

Effect of a 3% gelatin solution on urinary KIM-1 levels in patients after thyroidectomy: a preliminary randomized controlled trial

Effect of a 3% gelatin solution on urinary KIM-1 levels in patients after thyroidectomy: a preliminary randomized controlled trial

Flüssigkeits- und Volumentherapie mit kristalloiden und kolloidalen Lösungen

Gelatin and the risk of acute kidney injury after cardiac surgery

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