Evaluation of renal injury caused by acute volume replacement with hydroxyethyl starch 130/0.4 or Ringer's lactate solution in pigs

Abstract

This work aimed to evaluate the effects on renal tissue integrity after hydroxyethyl starch (HES) 130/0.4 and Ringer's lactate (RL) administration in pigs under general anesthesia after acute bleeding. A total of 30 mL/kg of blood were passively removed from the femoral artery in two groups of Large White pigs, under total intravenous anesthesia with propofol and remifentanil. After bleeding, Group 1 (n = 11) received RL solution (25 mL/kg) and Group 2 (n = 11) received HES 130/0.4 solution (20 mL/kg). Additionally, Group 3 (n = 6) was not submitted to bleeding or volume replacement. Pigs were euthanized and kidneys were processed for histopathological and immunohistochemical analyses. Minimal to moderate glomerular, tubular, and interstitial changes, as well as papillary necrosis, were observed in all experimental groups. Pre-apoptosis and apoptosis indicators were higher in pigs that received HES 130/0.4, indicating a higher renal insult. Both HES 130/0.4 and RL administration may cause renal injury, although renal injury may be more significant in pigs receiving HES 13/0.4. Results also suggest that total intravenous anesthesia with propofol and remifentanil may cause renal injury, and this effect can be dose related.

Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model

“…Several clinical studies have questioned the safety of HES in the treatment of critical ill patients (Guidet et al, 2012;Brunkhorst et al, 2008;Perner et al, 2012). Side effects such as increased risk of acute kidney injury, which requires renal replacement therapy and can even lead to mortality, have challenged the role of HES in the intensive care unit (Annane et al, 2013;Dellinger et al, 2013;Myburgh et al, 2012;Ferreira et al, 2018). Other detrimental effects of HES include increased perioperative blood loss and coagulopathy.…”

Peer Review #1 of "Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model (v0.1)"

“…Several clinical studies have questioned the safety of HES in the treatment of critical ill patients (8)(9)(10). Side effects such as increased risk of acute kidney injury, which requires renal replacement therapy and can even lead to mortality, have challenged the role of HES in the intensive care unit (11)(12)(13)(14). Other detrimental effects of HES include increased perioperative blood loss and coagulopathy.…”