Impact of 6% balanced hydroxyethyl starch following cardiopulmonary bypass on renal function: a retrospective study
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(2020) 15:237
RESEARCH ARTICLE
Open Access
Impact of 6% balanced hydroxyethyl starch following cardiopulmonary bypass on renal function: a retrospective study Ju Yong Lim1, Yun Seok Kim2
and Joon Bum Kim3*
Abstract Background: We aimed to evaluate the effect of limited volume of hydroxyethyl starch (HES) administration on postoperative renal function in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). Methods: One thousand six hundred fifty-seven patients undergoing cardiac surgery under CPB over two years were included. The patients were divided according to the amount of HES administrated during the first 2 days post-surgery; moderate dose HES (≥20 ml/kg) versus low dose HES (< 20 ml/kg). Outcomes were compared by using inverse probability weighting. Results: Incidence of acute kidney injury (AKI) was higher in the moderate HES group (p = .02). However, new renal replacement therapy (RRT) (P = .30) and early mortality (p = .97) was similar between the groups. When adjusted, the moderate HES use was associated with AKI (OR, 1.66; 95% CI, 1.12–2.44; p = .01), but did not increase the risk of new RRT (OR, 1.27; 95% CI, 0.71–2.18; p = .40) or early mortality (HR, 0.73; 95% CI, 0.29–1.81; p = .50). Conclusions: The moderate dose administration of HES (≥20 ml/kg) in the postoperative period following cardiac surgery might be associated with the risk of AKI. However, it was not associated with serious adverse outcomes such as new RRT or mortality. Further randomized controlled studies are needed to validate study results. Keywords: Hydroxyethyl starch, Acute kidney injury, Cardiopulmonary bypass
Background Synthetic colloids, hydroxyethyl starch (HES), have been widely used for perioperative fluid resuscitation in conjunction with crystalloids. With large molecular weight, HES is more effective volume expander than crystalloids with less pulmonary fluid accumulation and weight gain [1]. Thus, HES was used for pump priming and perioperative fluid therapy in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) who experienced increased capillary leakage in the immediate postoperative period. Despite of this beneficial aspect of * Correspondence: [email protected] 3 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea Full list of author information is available at the end of the article
HES, the toxic effects of HES are known to primarily involve the kidney by the accumulation of substitution of HES molecule in the kidney. Therefore, several randomized clinical trials [1–3] and meta-analysis [4] demonstrated the risks of HES administration outweigh the benefits compared to crystalloids in critically ill patients. Especially, as patients who undergo cardiac surgeries may be vulnerable to acute kidney injury (AKI) with nonpulsatility of flow and inflammatory response caused by CPB during surgery [5, 6], use of HES has been limited following cardiac
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