Impact of 6% Starch 130/0.4 and 4% Gelatin Infusion on Kidney Function in Living-Donor Liver Transplantation

Demir, Aslı; Aydınlı, Bülent; Toprak, Hüseyin; Karadeniz, Ümit; Yılmaz, Fatih; Züngün, Cevdet; Uçar, Perihan; Güçlü, Çiğdem Yıldırım; Bostanci, Emre; Yılmaz, Serdar

doi:10.1016/j.transproceed.2015.05.015

Cited by 18 publications

(16 citation statements)

References 27 publications

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“…Table 6 shows the results of 10 RCTs that reported the effects of fluids on renal function. Five trials [ 15 – 18 , 27 ] compared colloids to crystalloids and five trials [ 20 , 26 , 33 , 38 , 47 ] compared HES to other colloids or human albumin. Ando et al [ 18 ] compared low molecular weight HES (HES 70/0.5 or Hespander) to acetate Ringer's solution and found a significant difference in the glomerular filtration rate (GFR) and the urinary microalbumin/Cr ratio from intraoperative evaluations to discharge.…”

Section: Resultsmentioning

confidence: 99%

“…However, two studies found that HES administration had better tubular and glomerular function based on the RIFLE criteria and the level of serum Cr [ 33 , 47 ]. Also, another study found a lower incidence of AKI grade 1 compared to gelatin [ 20 ]. Other trials showed no significant difference in AKI using HES compared to albumin [ 26 , 38 ] or HES compared to crystalloids [ 18 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…In comparisons of HES to other colloids, HES 200/0.62 (Elohes) showed better renal function than 4% gelatin (Gelofusine) in two studies [33,47] using Cr and urine albumin as the parameters. Demir et al [20] compared HES 130/0.4 (Voluven) to 4% gelatin (Gelofusine) in patients who underwent a liver transplant and reported a nonsignificant incidence of acute kidney injury (AKI) grade I in the gelatin group (2 vs. 5). Two studies [26,38] compared HES 130/0.4 (Voluven) to 5% human albumin and reported no differences in the renal dysfunction at neither immediate postoperation [36,38] nor 3-month postoperation [38] using the cystatin C/Cr ratio.…”

Section: Renal Function (Colloid Vs Colloid/crystalloid)mentioning

confidence: 99%

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Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Noonpradej

Akaraborworn

2020

Critical Care Research and Practice

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Background. Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. Since the most suitable type of fluid is debatable, a consensus in perioperative patients has not been reached. Method. We performed a systematic review of randomized control trials (RCTs) that compared two or more types of fluids in major abdominal surgery. The outcomes were related to bleeding, hemodynamic status, length of hospital stay, and complications, such as kidney injury, electrolyte abnormality, major cardiac adverse event, nausea, vomiting, and mortality. A literature search was performed using Medline and EMBASE up to December 2019. The data were pooled to investigate the effect of fluid on macrocirculation and intravascular volume effect. Results. Forty-three RCTs were included. Eighteen fluids were compared: nine were crystalloids and nine were colloids. The results were categorized into macrocirculation and intravascular volume effect, microcirculation, anti-inflammatory parameters, vascular permeability, renal function (colloids), renal function and electrolytes (crystalloids), coagulation and bleeding, return of bowel function, and postoperative nausea vomiting (PONV). We found that no specific type of fluid led to mortality and every type of colloid was equivalent in volume expansion and did not cause kidney injury. However, hydroxyethyl starch and dextran may lead to increased bleeding. Normal saline can cause kidney injury which can lead to renal replacement therapy, and dextrose fluid can decrease PONV. Conclusion. In our opinion, it is safe to give a balanced crystalloid as the maintenance fluid and give a colloid, such as HES130/0.4, 4% gelatin, or human albumin, as a volume expander.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Renal Function (Colloid Vs Colloid/crystalloid)mentioning

confidence: 99%

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Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Noonpradej

Akaraborworn

2020

Critical Care Research and Practice

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“…In recent years, use of gelatine-based colloids has increased due to the unclear status of HES. However, beneath the risk of anaphylaxis and kidney injury, evidence concerning the risk profile of GP remains scarce (Moeller et al, 2016;Demir et al, 2015). Fast and effective therapy for hemorrhagic shock is indispensable.…”

Section: Discussionmentioning

confidence: 99%

Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model

Ziebart

Ruemmler

Möllmann

et al. 2020

PeerJ

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Background Fast and effective treatment of hemorrhagic shock is one of the most important preclinical trauma care tasks e.g., in combat casualties in avoiding severe end-organ damage or death. In scenarios without immediate availability of blood products, alternate regimens of fluid resuscitation represent the only possibility of maintaining sufficient circulation and regaining adequate end-organ oxygen supply. However, the fluid choice alone may affect the extent of the bleeding by interfering with coagulation pathways. This study investigates the impact of hydroxyethyl starch (HES), gelatine-polysuccinate (GP) and balanced electrolyte solution (BES) as commonly used agents for fluid resuscitation on coagulation using a porcine hemorrhagic shock model. Methods Following approval by the State and Institutional Animal Care Committee, life-threatening hemorrhagic shock was induced via arterial blood withdrawal in 24 anesthetized pigs. Isovolumetric fluid resuscitation with either HES, GP or BES (n = 3 × 8) was performed to compensate for the blood loss. Over four hours, hemodynamics, laboratory parameters and rotational thromboelastometry-derived coagulation were analyzed. As secondary endpoint the porcine values were compared to human blood. Results All the agents used for fluid resuscitation significantly affected coagulation. We measured a restriction of laboratory parameters, clot development and clot firmness, particularly in HES- and GP-treated animals. Hemoglobin content dropped in all groups but showed a more pronounced decline in colloid-treated pigs. This effect was not maintained over the four-hour monitoring period. Conclusion HES, GP, and BEL sufficiently stabilized the macrocirculation, but significantly affected coagulation. These effects were most pronounced after colloid and particularly HES administration. Despite suitability for rapid hemodynamic stabilization, colloids have to be chosen with caution, because their molecular properties may affect coagulation directly and as a consequence of pronounced hemodilution. Our comparison of porcine and human coagulation showed increased coagulation activity in pig blood.

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“…This has also been demonstrated in studies where kidney function after liver transplant was studied with living donors. 27 The effect of gelatin on kidney function in septic patients has been compared with the effect of crystalloids, and the conclusion has been that using gelatin results more frequently in acute kidney injury. 28 Thus, it is difficult to generalize the effects of gelatin on kidneys.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Limnell

Schramko²

2018

Exp Clin Transplant

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Objectives: Fluid therapy is required to maintain perfusion to donor organs. Recent reviews on the choices of fluids have emphasized the safety of using crystalloids, as opposed to fluid therapy with colloids, which has been reported to be either unequivocally or potentially harmful in a number of studies on various patient populations. We aimed to analyze whether the type of fluid administered to donors is connected with kidney transplant outcomes. Materials and Methods: A total of 100 consecutive braindead multiorgan donors and their respective 181 kidney recipients were studied retrospectively. Data concerning donor fluid therapy, the charac teristics of the donors and the recipients, and outcomes after kidney transplant were extracted from organ retrieval and patient records. Cases with early graft function were compared with cases with delayed graft function. Results: Donors had received both crystalloids and colloids in most cases (84%). Fluid therapy with crystalloids alone was more common among the 40 recipients with delayed (30%) than in the 103 recipients with early graft function (11%) (P = .005). Donor age, time on renal replacement therapy before transplant, and donor fluid therapy with crystalloids alone were independent risk factors for delayed graft function in multivariate analysis. Conclusions: Our results suggest that donor fluid therapy including colloids could be beneficial instead of harmful compared with treatment with crystalloids alone. This finding needs to be evaluated in prospective studies.

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Impact of 6% Starch 130/0.4 and 4% Gelatin Infusion on Kidney Function in Living-Donor Liver Transplantation

Cited by 18 publications

References 27 publications

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model

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