Influence of 6% Hydroxyethyl Starch 130/0.4 Versus Crystalloid Solution on Structural Renal Damage Markers After Coronary Artery Bypass Grafting: A Post Hoc Subgroup Analysis of a Prospective Trial

Thomas Datzmann, Markus Hoenicka, Helmut Reinelt, Andreas Liebold, Hagen Gorki
Journal of Cardiothoracic and Vascular Anesthesia 2018, 32 (1): 205-211

OBJECTIVE: The restriction of hydroxyethyl starch (HES) has mandated changes in volume management based on data of critically ill patients. Reliable data of structural renal damage after HES treatment in cardiac surgical patients are lacking. The influence of 6% HES 130/0.4 was investigated in this study.

DESIGN: An exploratory post hoc subgroup analysis of a prospective trial was performed.

SETTING: The study was carried out at a university hospital.

PARTICIPANTS: Forty-four low-risk cardiac surgical patients were examined.

INTERVENTIONS: Twenty-two patients received only crystalloid solutions, and 22 were treated with balanced 6% HES 130/0.4.

MEASUREMENTS AND MAIN RESULTS: Functional renal parameters and the structural biomarkers α-glutathione S-transferase, kidney injury molecule-1, liver fatty acid-binding protein, and neutrophil gelatinase-associated lipocalin were investigated. Volume balances, vasopressor dosages, blood losses, and coagulation parameters were compared. Most functional and structural renal parameters did not differ between the groups (serum creatinine p = 0.8380). Liver fatty acid-binding protein was transiently higher in the HES group only at 24 hours postoperatively (p = 0.0002). No differences in mortality, acute kidney injury, and need for renal replacement therapy were observed. Blood coagulation was significantly more compromised in the HES group at intensive care unit arrival (factor II, p = 0.0012; factor X, p = 0.0031; thrombocytes, p = 0.0010). Blood losses, and vasopressor dosages tended to be higher in HES-treated patients without significance.

CONCLUSION: Overall, the values and time courses of the biomarkers used did not indicate evidence of a mechanism for tubular injury caused by HES.

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