Modern hydroxyethyl starch and acute kidney injury after cardiac surgery: a prospective multicentre cohort

Abstract

The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.

The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial

“…However, in one prospective multi‐centre cohort study, peri‐operative use of 6% HES 130/0.4 for cardiac surgery did not increase the risk of renal replacement therapy (OR 0.99) . Rather, the non‐HES group required more intra‐operative vasopressors and had longer bypass times .…”

“…In a retrospective study, adults who received 6% HES 130/0.4 were twice as likely to develop postoperative AKI and they produced reduced urine output compared with those given crystalloids . However, in one prospective multi‐centre cohort study, peri‐operative use of 6% HES 130/0.4 for cardiac surgery did not increase the risk of renal replacement therapy (OR 0.99) . Rather, the non‐HES group required more intra‐operative vasopressors and had longer bypass times .…”

Goal-directed fluid restriction using stroke volume variation and cardiac index during one-lung ventilation: a randomized controlled trial

“…we therefore decide to use colloid instead of crystalloid in the GDFR protocol. Although it is not always ideal to use a colloidal solution, as anesthesiologists need to consider various factors, such as nephrotoxic effects (39). However, in the present study, there was no significant difference in the urine volume and postoperative renal complications, which suggested that the bolus of hydroxyethyl starch solution we used not exceed the kidney compensatory.…”

Response: Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery

“…Studies did not identify any differences in the incidence of death or AKI in cardiac surgical patients receiving intraoperative synthetic colloid. [2][3][4][5][6][7][8] Dr. Reinhart's group published a prospective study in 6,478 consecutive cardiac surgical patients. 9 With propensity matching, predominant use of hydroxyethyl starch (HES) 130/0.4 was associated with increased utilization of renal replacement therapy.…”

“…On the contrary, the majority of studies in the cardiac surgery population failed to find an association between the use of HES and postoperative AKI, blood loss, and mortality. [4][5][6][7] Even the HES 130/0.4 or 130/0.42 raw material has been studied and did not have a significant influence on perioperative blood loss. Moreover, the authors did not find any effect of tetrastarch raw material composition on short-and long-term renal function.…”