Renal impact of fluid management with colloids: a comparative review

Davidson, Ingemar

doi:10.1017/s0265021506000639

Cited by 118 publications

(56 citation statements)

References 119 publications

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“…10,[11][12][13][14]26,29 However, this was not supported by our study. During 2003 to 2013, HES solutions used at Helsinki University Hospital were all thirdgeneration solutions compared with the first-and second-generation solutions used in earlier studies.…”

Section: Discussioncontrasting

confidence: 91%

“…Other studies have shown that gelatin does not have a significant role in kidney damage occurrence in septic elderly patients. 25 However, studies have reported gelatin to elevate postoperative creatinine levels 26 compared with crystalloids, indicating renal damage. This has also been demonstrated in studies where kidney function after liver transplant was studied with living donors.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Untitled

Limnell

Schramko²

2018

Exp Clin Transplant

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“…Choice, timing, and amount of fluid administration are also emerging as important determinants of AKI, with some concerns raised over the use of certain forms of colloid, namely hydroxyethyl starch (31)(32)(33). In a randomized study of septic patients, Schortgen et al (34) found that patients who were randomly assigned to hydroxyethyl starch had a much higher risk for acute renal failure, oliguria, and higher peak creatinine than those who were randomly assigned to gelatin.…”

Section: Prevention/protection Strategiesmentioning

confidence: 99%

Potential Interventions in Sepsis-Related Acute Kidney Injury

Ronco¹,

Kellum²,

Bellomo³

et al. 2008

Clinical Journal of the American Society of Nephrology

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Sepsis is an important cause of morbidity and mortality. Acute kidney injury often complicates sepsis, leading to greater complexity, cost of care, and worsening prognosis. In recent years, a consensus definition of acute kidney injury has been developed, facilitating research into the pathophysiology and epidemiology of this disorder. New and emerging biomarkers to recognize kidney injury before functional abnormalities are manifest may allow early recognition and facilitate prevention or treatment. Furthermore, advances in the clinical management of sepsis may have secondary benefits with respect to renal outcomes. Existing and hybrid extracorporeal therapies are being investigated not only as means to replace lost kidney function but also to modulate the immune response to sepsis. For those who have more advanced forms of kidney injury, strategies to promote renal recovery are being sought to minimize the long-term consequences of impaired kidney function. This review provides an update on the current state of the science and a glimpse toward the future of intervention in sepsis-related acute kidney injury.

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confidence: 99%

“…For example, in randomized trials both iso-and hyperoncotic HES solutions have increased the incidence of ARF in patients with severe sepsis or septic shock [5]. Conversely, in model system studies and clinical trials albumin solutions, including hyperoncotic albumin, have displayed renoprotective activity [1,4]. Further mechanistic studies are needed to define more precisely the effects of colloids on the kidney.…”

mentioning

confidence: 99%

Resuscitation with hyperoncotic colloids in the intensive care unit

Wiedermann

2008

Intensive Care Med

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Sir, Artificial colloids display nephrotoxicity, and the pathophysiological mechanisms are of considerable clinical interest [1]. In a cohort study report, Schortgen and collaborators [2] pose the question whether ''highoncotic forces rather than the chemical nature of fluids have a deleterious effect on renal function''. Unfortunately, the question is left unanswered.The study population of 1,013 intensive care unit patients was divided into four groups according to whether they received (1) crystalloids only, (2) hypo-oncotic colloids (gelatins and/or 4% albumin) with or without crystalloids, (3) artificial hyperoncotic colloids with or without crystalloids or hypo-oncotic colloids, or (4) hyperoncotic 20-25% albumin with or without crystalloids or other colloids. Dextrans and/or hydroxyethyl starches (HES) were placed in the hyperoncotic artificial colloid category. This classification scheme of itself already makes the study uninterpretable.The in vitro colloid osmotic pressure (COP) of human plasma is approximately 28 mmHg, and resuscitation fluids of comparable in vitro COP expand the intravascular space by roughly 100% of the administered volume. Such fluids are iso-oncotic. Concentration is a powerful determinant of oncotic properties. All 6% HES solutions, regardless of molecular weight and substitution, are essentially isooncotic, whereas 10% HES with an in vitro COP of 80 mmHg is hyperoncotic [3]. Therefore, the designated artificial hyperoncotic colloid group evidently received an unspecified mixture of iso-and hyperoncotic fluid.Oncotic forces in vivo will also heavily depend on the volumes and properties of co-administered fluids. There was no accounting for concomitant crystalloid used in the three colloid groups or of other colloids with different oncotic properties in the two hyperoncotic colloid groups. Crucially, the plasma COP after fluid infusion was not measured. Consequently, the actual oncotic forces at work in patients remained totally undefined.Further confounding interpretation was clear bias in fluid selection. Hyperoncotic colloids were reserved for the sickest patients, as evidenced by significantly greater organ dysfunction, high-dose vasopressor use and need for mechanical ventilation at study entry. Multivariate adjustment and propensity scores were applied, but these methods cannot correct for unmeasured variables, and numerous known independent risk factors for acute renal failure (ARF) were not evaluated in this study. Indeed randomized trial evidence makes plain that the attempts to adjust for bias were unsuccessful. Thus, Schortgen et al. observed poorer renal function and increased mortality in the hyperoncotic albumin group. In contrast, in a recent metaanalysis of 25 randomized clinical trials evaluating hyperoncotic albumin for volume expansion among 1,485 total patients, there was no evidence of renal injury due to hyperoncotic albumin and no effect on survival (relative risk 0.95; 95% confidence interval 0.78-1.17) [4].Available evidence shows that the type of fluid ca...

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Renal impact of fluid management with colloids: a comparative review

Abstract: Colloids display important differences in their actions on the kidney. These contrasting renal effects should be considered in making fluid management decisions.

Cited by 118 publications

References 119 publications

Untitled

Untitled

Potential Interventions in Sepsis-Related Acute Kidney Injury

Resuscitation with hyperoncotic colloids in the intensive care unit

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