Abstract
Background: A 6% hydroxyethyl starch (Hespander®, Fresenius-Kabi Japan; HES) solution is generally used for perioperative fluid optimization, though intraoperative use of large amounts is regulated because of possible renal failure or other complications. On the other hand, some studies found that HES70/0.5, with the lowest molecular weight and molar substitution rate, did not affect renal function. In this retrospective study, we investigated the effect of intraoperative use of a large volume of HES70/0.5 on postoperative renal function. Methods: Hospital electronic medical records of adult patients who had undergone surgery with general anesthesia without blood transfusion were retrospectively reviewed. Those with an intraoperative administration of ≥ 2000 ml of HES were classified as the HES group, while patients who received <1000 ml were used as the control group. They were matched based on amount of estimated total blood loss and total fluid administration. The groups were compared for serum hemoglobin, albumin, and creatinine levels obtained in preoperative and postoperative examinations. We also investigated other postoperative complications. Results: There were 109 patients in the HES group and 109 in the control group. No significant differences in amount of intraoperative urinary output and infused 5% albumin between the groups were found. In the control, crystalloids were given significantly more often (p<0.05). Although there was no significant difference in preoperative creatinine level, that was significantly higher in the HES group on postoperative day 1 (0.90 ± 0.26 mg/dl) as compared to the control (0.81 ± 0.33 mg/dl) (p<0.05). The number of patients postoperatively diagnosed with acute kidney injury or who required renal replacement therapy was not significantly different. Conclusion: Our findings suggest that intraoperative use of a large volume of HES70/0.5 can increase serum creatinine in the postoperative period. However, it remains unclear whether HES at ≥ 2000 ml induces complications.
Highlights
A 6% hydroxyethyl starch (Hespander®, Fresenius-Kabi Japan; HES) solution is widely used in Japan for plasma volume expansion
In Japan, use of the HES product with the lowest molecular weight and molar substitution rate of all related products is mandated, namely, an average molecular weight of 70,000 and molar substitution rate of 0.5 (HES70/0.5). This is different from standard HES, which has been associated with increased risk of renal injury or other complications in previous reports [10,11,12], while other studies [8,9,13], have concluded that HES70/0.5 does not have an effect on renal function
We examined whether intraoperative use of a large volume of HES70/0.5 has effects to induce postoperative renal dysfunction
Summary
Hospital electronic medical records of adult patients who had undergone surgery with general anesthesia without blood transfusion were retrospectively reviewed. Those with an intraoperative administration of ≥ 2000 ml of HES were classified as the HES group, while patients who received
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