Modern hydroxyethyl starch and acute kidney injury after cardiac surgery: a prospective multicentre cohort
Vives M (1), Callejas R (2), Duque P (2), Echarri G (2), Wijeysundera DN (3,4,5), Hernandez A (6), Sabate A (7), Bes-Rastrollo M (8,9,10), Monedero P (2).
(1) Anaesthesia & Intensive Care, Hospital Universitari Bellvitge, Universitat de Barcelona, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907, Spain
(2) Anesthesiology & Critical Care, Clinica Universidad de Navarra, Avenida Pio 12, 36, 31008 Pamplona, Spain.
(3) Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Toronto, ON, Canada.
(4) Department of Anesthesia and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
(5) Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.
(6) Department of Anesthesiology and Critical Care, University Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK.
(7) Department of Anesthesiology and Critical Care, Bellvitge University Hospital, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907, Spain.
(8) Department Preventive Medicine and Public Health, University of Navarra, Av. Pio XII, 36, 31008 Pamplona, Spain.
(9) CIBERobn, Instituto de Salud Carlos III, Spain.
(10) IDISNA, Navarra's Health Research Institute, Spain.
Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients.
In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals.
We identified 350 patients (33%) administered 6% HES 130/0.4 intraoperatively and postoperatively, and 377 (36%) experienced postoperative AKI (AKI Network criteria). In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES group had higher Euroscore and more comorbidities including unstable angina, preoperative cardiogenic shock, preoperative intra-aortic balloon pump use, peripheral arterial disease, and pulmonary hypertension.
The non-HES group received more intraoperative vasopressors and had longer cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES 130/0.4 use was not associated with significantly increased risks of AKI (adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were confirmed by propensity score-matched pairs analyses.
The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.
CITATION Br J Anaesth. 2016 Oct;117(4):458-463. doi: 10.1093/bja/aew258. Epub 2016 Oct 17