Abstract:
BACKGROUND:Hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients admitted to intensive care unit (ICU) for medical indications. We conducted a cohort study to evaluate the renal safety of modern 6% HES solutions in high-risk patients having cardiac surgery. METHOD:In this multicentre prospective cohort study, we recruited 261 consecutive patients at high-risk for developing cardiac surgery-associated AKI, based on a Cleveland score ≥ 4 points, from July to December 2017th in 14 hospitals in Spain and the United Kingdom. Multivariable logistic regression modeling and propensity-score matched-pairs analysis were used to determine the adjusted association between administration of HES and AKI. RESULTS:Of the cohort, 95 patients (36.4%) received 6% HES 130/0.4 either intraoperatively or postoperatively. Postoperative AKI occurred in 145 patients (55.5%). The unadjusted odds of AKI was significantly higher in the HES group, when compared to those not receiving HES (OR 2.22, 95% CI 1.30-3.80, p = 0.003). In multivariable logistic regression models, modern HES was not associated with significantly increased risk of AKI (adjusted OR 0.84, 95% CI 0.41-1.71, p = 0.63). In propensity score match-pairs analysis of 188 patients, the HES group experienced similar adjusted odds of AKI (OR 1.05, CI 95% 0.87-1.27, p = 0.57) and RRT (OR 1.06, CI 95% 0.92-1.22, p = 0.36). CONCLUSIONS:The use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with an increased risk of AKI nor dialysis in this cohort of patients at elevated risk for developing AKI after cardiac surgery.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Nagore D,Candela A,Bürge M,Monedero P,Tamayo E,Alvarez J,Murie M,Wijeysundera Dn DN,Vives M,Spanish Perioperative Cardiac Surgery Research Group.doi
10.1016/j.jclinane.2021.110367keywords:
["Acute kidney injury","Cardiac surgery","High risk patients","Hydroxyethyl starch","Renal replacement"]subject
Has Abstractpub_date
2021-10-01 00:00:00pages
110367eissn
0952-8180issn
1873-4529pii
S0952-8180(21)00206-3journal_volume
73pub_type
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