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

Abstract

We have evaluated the effect of a colloid solution on acute kidney injury in paediatric cardiac surgery. A total of 195 patients were ramdomly divided into an hydroxyethyl starch group and a control group. In the starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte ) was used as the primary fluid for volume resuscitation but was limited to 30 ml.kg . In the control group, only crystalloid fluid was used during the peri-operative period. The incidence of acute kidney injury, peri-operative transfusion, clinical outcomes and laboratory data were compared. The incidence of acute kidney injury determined by Paediatric Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute Kidney Injury Network (AKIN) criteria were no different between the two groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no differences in clinical outcomes such as mortality, major adverse events, intensive care unit stay or duration of mechanical ventilation. Clotting time as measured using rotational thromboelastometry (ROTEM) was prolonged, and clot firmness after 10 min and maximal clot firmness were shorter in the starch group compared with the control group after sternal closure. There was no difference in transfusion between the two groups. Patients with acute kidney injury had worse clinical courses than those without acute kidney injury. We conclude that intra-operative use of 6% hydroxyethyl starch 130/0.4 up to 30 ml.kg was not associated with postoperative acute kidney injury in paediatric cardiac patients.

Response: Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery

“…No difference was observed regarding the incidence of postoperative renal failure requiring renal replacement therapy, morbidity, or mortality, especially with the intraoperative use of 6% HES 130/0.4 up to 30 mL/kg. [11][12][13] These results confirm that the use of HES for volume replacement in children during cardiac surgery with cardiopulmonary bypass is as safe as albumin. In addition, its use might be associated with less fluid accumulation.…”

“…Intraoperative use of HES was associated with a less positive fluid balance. 2,[11][12][13] Perioperative hemostasis, blood loss, volume of red blood cells, and fresh frozen plasma administered, as well as the number of children who received transfusions, also were significantly lower in the HES group. No difference was observed regarding the incidence of postoperative renal failure requiring renal replacement therapy, morbidity, or mortality, especially with the intraoperative use of 6% HES 130/0.4 up to 30 mL/kg.…”

Pediatric Acute Kidney Injury: Focusing on Diagnosis and Management

“…Crystalloids are the preferred solu tions because data supporting the routine use of colloids for volume resuscitation are lacking 43) . Colloid solution was not superior to crystalloid in terms of the prevention of AKI in children who underwent cardiac surgery 44) . Among crystalloids, some studies have reported that a balanced solution, such as Ringer's lactate solution, is superior to normal saline 45) .…”

Safety of Albumin and Hydroxyethyl Starch as Priming Fluid for Cardiopulmonary Bypass in Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

“…The inconsistent results may be due to the molecular weight of HES. In their study they used macromolecular HES [29] . As the molecular weight of HES decreases, its effect on renal function becomes less.…”