Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial

Abstract

Background:The ideal strategy to prime the cardiopulmonary bypass (CPB) circuit in adult cardiac surgery is still a matter of debate.Objectives:In this retrospective study, we examined Albumin solution and hydroxyethyl starch (HES) for priming the CPB circuit and evaluated the differences in kidney function and bleeding and coagulation status in the two groups of patients.Patients and Methods:Sixty consecutive patients undergoing elective coronary artery bypass grafting were studied. Patients were excluded due to emergency surgery, history of cardiac surgery, history of receiving medication with antiplatelet agents except ASA 80 (mg/day) within the previous five days, preoperative coagulation disorder, left ventricular ejection fraction less than 50%, preoperative renal dysfunction (serum creatinine > 1.4 mg/dL), preoperative hepatic dysfunction (serum aspartate/alanine amino transferase > 60 U/l), preoperative electrolyte imbalance, known hypersensitivity to HES and chronic diuretic therapy. The patients were divided randomly into two groups of HES (n = 30) and Albumin (n = 30). Hemodynamic parameters, serum creatinine concentrations and glomerular filtration rate, PT, PTT and INR were measured. Early bleeding was measured according to the first 24-hour drainage from the tube. Hemodynamics and all laboratory measurements were performed after induction of anesthesia and at the morning of the first, second and third postoperative days in the ICU.Results:GFR differences were statistically lower in Albumin group in comparison with Group B at 24, 48 and 72 hours postoperation. Platelet count difference and postoperative bleeding were significantly lower in Albumin group.Conclusions:Administration of Albumin compared to HES in patients with a normal renal function results in a lower drop of GFR and platelet count, less bleeding and lower rise of serum creatinine.

The comparison of albumin and 6% hydroxyethyl starches (130/0.4) in cardiac surgery: a meta-analysis of randomized controlled clinical trials

“…As shown in Additional file 1 : Figure S2, the allocation concealment was not described in three trials [ 17 , 20 , 21 ]. The blinding of participants and personal was not described in one trial [ 13 ].…”

“…The blinding of participants and personal was not described in one trial [ 13 ]. The blinding of outcome assessment was not described in four studies [ 14 , 17 , 19 , 20 ]. The blinding of outcome assessment was not used in one trial [ 16 ].…”

Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery

“…The clinical significance of observed differences in the outcome should be investigated in further studies. Avoidance of excessive crystalloids and goal-directed fluid therapy may decrease the cardiac load and reasonably reduce the damage to end-organs, such as the renal system (18)(19)(20). Further studies with the early biomarkers of AKI are warranted.…”

The Effect of Desmopressin on the Amount of Bleeding in Patients Undergoing Coronary Artery Bypass Graft Surgery with a Cardiopulmonary Bypass Pump After Taking Anti-Platelet Medicine

“…Using a cardiopulmonary pump in cardiac surgery may induce blood coagulation disorders and platelet dysfunction, requiring transfusion of proper functioning platelets or the administration of other medicines (3-6). Up until now, diverse products including desmopressin, albumin, recombinant factor VII, and tranexamic acid have been used to reduce bleeding after cardiac surgery (12, 15, 18-20). Desmopressin is an artificial form of vasopressin or an antiduretic hormone (ADH) analogue that exerts its anti-hemorrhagic effects through increased plasma levels of factor VΙΙΙ and increased activity of the Von Willebrand factor.…”