Abstract
PurposeWe aimed to compare retrospectively the rates of renal morbidity and mortality in surgical patients receiving 6% HES 130/0.4 to those receiving albumin.MethodsFrom a Japanese nationwide medical database between 2014 and 2016, we identified adults who received HES 130/0.4 (HES group) or albumin (albumin group) as a single colloid solution on the day of surgery. After propensity score matching, the two groups were analyzed with χ2 or Mann Whitney U test. The primary outcome was the incidence of acute kidney injury (AKI). Secondary outcomes included the incidence of renal-replacement therapy, hospital length of stay, in-hospital 30-day mortality, the use of vasoactive agents, and the fluid requirement on the day of surgery.ResultsOf 76,048 patients in the database, propensity score matching identified 289 matched pairs. There was no statistically significant difference in the incidence of AKI between the HES and the albumin group (15.2% vs. 20.8%, respectively: P = 0.08). The secondary outcomes did not differ between groups except the following. Median hospital stay was 5 days shorter in the HES group (18 vs. 23 days; P < 0.001), and the median net fluid requirement on the day of surgery was 15 mL/kg lower in the HES group (140 vs. 155 mL/kg, respectively; P = 0.01).ConclusionsPostoperative renal morbidity and mortality did not differ between patients receiving HES 130/0.4 and those receiving albumin. HES 130/0.4 was associated with shorter hospital stay and less fluid requirement compared to albumin. These findings support the use of 6% HES 130/0.4 for perioperative volume replacement as an alternative to albumin.Trial registrationUMIN000027896 and the date of registration was June 30, 2017 at https://www.umin.ac.jp/ctr/index-j.html.
Highlights
Fluid resuscitation in surgery has been debated regarding a liberal versus a restricted strategy [1,2,3,4], consensus statement of Enhanced Recovery After Surgery (ERAS) recommended a goal directed fluid therapy (GDFT)Studies of critically ill nonsurgical patients showed that colloids, including albumin and hydroxyethyl starch (HES), were no better and sometimes less effective than crystalloids in reducing renal morbidity [6,7,8,9,10]
No data were missing in the covariates, but in the matching process, no patient had portal hypertension as a preoperative comorbidity, and none underwent open thoracic surgery in the albumin group (Table 3), so these two covariates were excluded from the calculation of standardized difference and propensity score for mathematical reason
The two groups did not differ in the incidence of acute kidney injury (AKI) (HES, 15.2% vs. albumin, 20.8%: OR, 0.69; 95% CI, 0.45–1.05), worsening stage of AKI
Summary
Studies of critically ill nonsurgical patients showed that colloids, including albumin and hydroxyethyl starch (HES), were no better and sometimes less effective than crystalloids in reducing renal morbidity [6,7,8,9,10]. A recent multicenter randomized trial for high-risk abdominal surgery compared HES 130/0.4 with crystalloid using Doppler-guided GDFT and showed no evidence of renal toxicity in patients receiving HES 130/0.4 [11]. A study of patients undergoing cardiac surgery using a propensity score-matching method showed that albumin was dose-dependently associated with increasing risk of acute kidney injury (AKI) [16]. In studies of children undergoing cardiac surgery [19, 20] and in adults undergoing elective cystectomy [21], renal morbidity and safety profiles of HES 130/0.4 did not differ from those of albumin. A study reported that using 6% HES 130/0.4 as an alternative to albumin could potentially reduce the amount of albumin used to treat surgical bleeding by up to 80% [22]
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