Incidence of Acute Oligoanuric Renal Failure in Dextran 40 Treated Patients with Acute Ischemic Stroke Stage III or IV

Abstract

Two hundred eleven patients with acute ischemic stroke, stage III or IV, received daily intravenous infusion of 500-1000 mL low-molecular dextran (dextran 40) over a period of 4 days. In 10 cases (4.7%) acute renal failure, associated with dextran infusion, could be observed; oligoanuria occurred after a mean time of 4 (3-6) days. The incidence of dextran-induced acute renal failure was significantly higher in patients with a preexisting reduction of glomerular filtration rate below 30 mL/min/1.73 m2 (p < 0.005). Five of the patients (50%) with acute renal failure died within 4-12 days after the hemodilution therapy with dextran 40; this high lethality was due to nonrenal complications.

Renal impact of fluid management with colloids: a comparative review

“…Case reports have described more than 60 patients developing ARF attributable to dextran 40 administration [70][71][72]74,76,79,83,84,87,[90][91][92]95]. ARF associated with dextran 40 infusion was encountered in 4.7% out of 211 acute ischaemic stroke patients [63]. Plasmapheresis may be necessary to remove the dextran load [74,79,83,90,91,95].…”

“…A total of 92 studies were included in the review: 23 randomized clinical trials [6,11,12,15,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]; 17 non-randomized controlled clinical studies [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]; 16 non-controlled cohort clinical studies [54][55][56][57][58][59][60][61][62][63][64]…”

The influence of volume management on outcome

“…Several small studies have described oligo-anuric AKI with infusion of low molecular weight dextrans [29,[36][37][38]. HES has also been described to cause AKI, [14,39].…”

“…For example, these colloids are associated with increased rates of anaphylactoid reactions and prolonged pruritus [28]. In addition, these synthetic colloids can lead to coagulopathy and kidney injury [14,27,[29][30][31][32][33]. Impaired hemostasis has been attributed to hemodilution and to a direct effect on platelet function, coagulation factors (i.e.…”

A Systematic Review of the Comparative Safety of Colloids

“…89 In a cohort study of patients with acute ischemic stroke, 4.7% experienced acute renal failure associated with dextran infusion. 72 Gelatin, as compared with albumin as pump prime in cardiac surgery, elevated creatinine levels. …”