Hydroxyethyl Starch 130/0.4 and the Risk of Acute Kidney Injury After Cardiopulmonary Bypass: A Single-Center Retrospective Study

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 30; no. 4; pp. 869 - 875
• Main Authors: Lagny, Marc-Gilbert, MSci, Roediger, Laurence, MD, PhD, Koch, Jean-Noel, MSci, Dubois, Fanny, Senard, Marc, MD, PhD, Donneau, Anne-Françoise, PhD, Hubert, Marie Bernard, MD, PhD, Hans, Gregory A., MD, PhD
• Format: Journal Article Web Resource
• Language: English
• Published: United States Elsevier Inc 01.08.2016; W.B. Saunders
• Subjects: acute kidney injury; Acute Kidney Injury - etiology; Aged; Aged, 80 and over; Anesthesia & intensive care; Anesthesia & Perioperative Care; Anesthésie & soins intensifs; cardiac surgery; Cardiopulmonary Bypass - adverse effects; Critical Care; Female; Fluid Therapy - adverse effects; Fluid Therapy - methods; HES; Human health sciences; Humans; Hydroxyethyl starch; Hydroxyethyl Starch Derivatives - adverse effects; Hydroxyethyl Starch Derivatives - therapeutic use; Intraoperative Care - adverse effects; Intraoperative Care - methods; Isotonic Solutions - adverse effects; Isotonic Solutions - therapeutic use; Male; Middle Aged; Postoperative Complications; Postoperative Period; Retrospective Studies; Sciences de la santé humaine; Severity of Illness Index; hydroxyethyl starch; cardiac surgery; acute kidney injury; HES
• ISSN: 1053-0770; 1532-8422; 1532-8422
• DOI: 10.1053/j.jvca.2015.10.010

Objectives To investigate whether using hydroxyethyl starch (HES) 130/0.4 as a pump prime and for intraoperative fluid therapy is associated with postoperative acute kidney injury (AKI) after adult cardiac surgery. Design Retrospective observational study. Setting University hospital, single center. Participants Six hundred six adult patients who underwent on-pump cardiac surgery between April 2013 and June 2014 were included. Interventions Until July 2013, balanced HES 130/0.4 (Volulyte® , Fresenius Kabi AG, Bad Homburg, Germany) was used both as a pump prime (1,500 mL) and for intraoperative fluid therapy (1,000 mL). From August 2013, HES was replaced entirely by a balanced crystalloid solution (Plasma-Lyte A, Baxter, Lessines, Belgium). Measurements and Main Results The primary endpoint was the incidence of postoperative AKI during the first 48 postoperative hours, determined using the Acute Kidney Injury Network classification. Secondary outcomes included kidney function at postoperative day 7, postoperative dialysis or hemofiltration, postoperative pulmonary complications, lengths of intensive care unit and hospital stays, postoperative fluid balance and urinary output, surgical revision for bleeding, and 30-day mortality. Multivariable logistic regression was used to adjust for confounders. AKI occurred in 9.5% of crystalloid patients and in 21.5% of HES patients. Patients who received HES were about twice as likely to develop postoperative AKI as those treated with crystalloids (adjusted OR 2.26; 95% CI, 1.40-3.80; p = 0.02). HES patients also had a significantly more positive fluid balance and a lower urinary output during the first 48 postoperative hours. The incidence of surgical revision for bleeding was greater in the HES group (4.6% v 1.4%, p = 0.02). Conclusion This study suggested that using balanced HES 130/0.4 as a pump prime and for intraoperative fluid therapy in adult patients undergoing on-pump cardiac surgery was associated with a greater incidence of AKI during the early postoperative period.