Prevention of Acute Renal Failure - Fluid Repletion and Colloids

Abstract

Hypovolemia alone or in conjunction with other factors is a main reason for acute renal failure in critically ill patients. Various crystalloid and colloid solutions are available to correct hypovolemia. Some of them have been implicated in impairment of renal function. Infusion of large amounts of sodium chloride is associated with increased incidence of nausea, vomiting and hyperchloremic metabolic acidosis. While gelatins and HES are preferred colloids in patients with normal kidney function, there is some evidence that the latter are associated with impaired renal function in patients with pre-existing kidney disease. Any hyperoncotic colloid given in large amounts may decrease glomerular filtration, and should therefore be combined with crystalloids.

Spanish consensus statement on alternatives to allogeneic transfusions: the ‘Seville document’

“…As hydroxyethyl starch solutions have been proved to have a good safety profile, they are the synthetic colloids most commonly used for the correction of hypovolemia, and therefore there exists a large clinical experience on their use 83,89,90 . As a result, it can be said that hydroxyethyl starches are nowadays the products of election for the treatment of hypovolemia with colloids.…”

“…High‐molecular‐weight hydroxyethyl starch may worsen renal function in patients with a pre‐existing renal disease, 89 especially in septic patients 90 . In contrast, although altered laboratory parameters of hemostasis might be observed, the administration of low‐molecular‐weight hydroxyethyl starch solutions rarely results in clinically relevant coagulopathy leading to hemorrhagic complications.…”