Large volume infusions of hydroxyethyl starch during cardiothoracic surgery may be associated with postoperative kidney injury: propensity-matched analysis

Wataru Matsunaga,Masamitsu Sanui,Yasuma Kobayashi,Yusuke Sasabuchi,Fumitaka Yanase,Yutaka Takisawa,Alan Kawarai Lefor,Asuka Kitajima

doi:10.1186/s13741-019-0125-z

Abstract

BackgroundThe safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB).Materials and methodsPatients who underwent cardiothoracic surgery using CPB between 2007 and 2014 were retrospectively reviewed. The incidence of AKI within 7 days after surgery, defined by the Kidney Disease Improving Global Outcome criteria, was compared for patients who did or did not receive 6% (70/0.5) or 6% (130/0.4) HES for anesthesia management before or after CPB. Multivariable logistic regression and propensity matching analysis were performed to examine whether use of HES is associated with postoperative AKI. Outcomes comparing patients receiving HES ≥ 1000 mL and < 1000 mL were also compared.ResultsData from 1976 patients were reviewed. All patients received 70/0.5 HES as a part of the priming solution for CPB. The incidence of postoperative AKI was 28.2% in patients who received HES and 26.0% in patients who did not (p = 0.33). In multivariable analysis, there was no correlation between the use of HES and the incidence of AKI (odds ratio 0.87, 95% CI 0.30–2.58, p = 0.81). Propensity matching showed that the incidence of AKI was not significantly different between 481 patients administered with HES and 962 patients (26.6% vs. 26.9%, p = 0.95) who did not receive HES for anesthesia management. However, peak creatinine levels, needed for renal replacement therapy, and in-hospital mortality were higher, and 28-day hospital-free days were lower in patients receiving HES ≥ 1000 mL than those receiving HES < 1000 mL (p < 0.05).ConclusionsIntraoperative use of HES was not associated with postoperative AKI following CPB. However, administration of large volumes of HES may be associated with kidney-related adverse clinical outcomes.

Highlights

The safety of intraoperative administration of hydroxyethyl starch (HES) has been debated
There was no correlation between the use of HES and the incidence of acute kidney injury (AKI)
Propensity matching showed that the incidence of AKI was not significantly different between 481 patients administered with HES and 962 patients (26.6% vs. 26.9%, p = 0.95) who did not receive HES for anesthesia management

Summary

Introduction

The safety of intraoperative administration of hydroxyethyl starch (HES) has been debated. We hypothesized that intraoperative use of HES is associated with postoperative acute kidney injury (AKI) following cardiopulmonary bypass (CPB). Maintaining intravascular volume by fluid administration is essential to maintain stable hemodynamic status, but optimal perioperative fluid management including the types and the amount of fluid infused is a matter of continuing debate. Colloid solutions are often used with the expectation of maintaining intravascular volume and improving perioperative outcomes compared to crystalloids (Thompson and Walton 1964). Several studies showed that colloid solutions are harmful, including detrimental effects of hydroxyethyl starch (HES) on kidney function and overall prognosis. Whether the intraoperative use of HES has a detrimental effect on postoperative kidney function is controversial. Another systematic review suggested an increased risk of postoperative renal damage with the intraoperative use of HES (Ishihara 2014)

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Conclusion