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

The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial

“…With regard to cardiac surgical patients, the safety of colloid infusions has been questioned. In a retrospective study, adults who received 6% HES 130/0.4 were twice as likely to develop postoperative AKI and they produced reduced urine output compared with those given crystalloids . However, in one prospective multi‐centre cohort study, peri‐operative use of 6% HES 130/0.4 for cardiac surgery did not increase the risk of renal replacement therapy (OR 0.99) .…”

The dose of hydroxyethyl starch 6% 130/0.4 for fluid therapy and the incidence of acute kidney injury after cardiac surgery: A retrospective matched study

“…HES are given together with preexisting kidney dysfunction and/or hypoxia/ischemia, lysosomal digestion and degradation of vacuoles are impaired [ 21 ]. High doses of HES administered over a short time period in conjuction with a situation of ischemia/reperfusion, as is the case in surgrey with CPB, may explain the results obtained in the study conducted by Lagny et al [ 13 ] In our study the total volume of HES was administered over a much longer time period as compared with the study conducted by Lagny et al Nevertheless, in multivariable analysis we found that a larger dose of HES was associated with an increased incidence of AKI. This is an important finding as studies have not been conclusive regarding a safe dose of HES [ 20 ].…”

“…In this regard their results are not conclusive. In a very recent retrospective study in cardiac surgery, the authors showed that the use of balanced HES 6% 130/0.4 as a CPB prime and for intraoperative fluid therapy was associated with a greater incidence of AKI based on the Acute Kidney Injury Network Classification [ 19 ] when compared with a balanced crystalloid solution [ 13 ]. Their conclusions are in line with a large Cochrane review that recommends alternate volume replacement therapy in place of HES [ 20 ].…”

“…Their conclusions are in line with a large Cochrane review that recommends alternate volume replacement therapy in place of HES [ 20 ]. In the study conducted by Lagny et al [ 13 ] HES patients received a total dose of HES ranging from 2000 mL to 2500 mL (average dose around 30 mL/kg) during the short time period of the surgery. The administration of large doses of exogenous solutes such as HES over a short time period may result in osmotic nephrosis [ 21 ].…”

“…Cardiac surgery-associated acute kidney injury can occur in up to 30% of the patients [ 7 – 9 ], and is associated with an increased incidence of mortality [ 10 – 12 ]. The results of a recent retrospective study suggested that using HES 6% 130/0.4 for cardiopulmonary bypass (CPB) prime and intraoperative fluid therapy at an average dose of 30 mL/kg was associated with a greater incidence of AKI after on-pump adult cardiac surgery when compared with fluid therapy based on crystalloids only [ 13 ]. To date no study has evaluated the association between the total dose of HES 6% 130/0.4 administered in the perioperative period and the incidence of AKI after adult cardiac surgery.…”