CRITICAL CARE Effects of hydroxyethyl starch administration on renal function in critically ill patients†‡
Y. Sakr1, D. Payen2, K. Reinhart1, F. S. Sipmann3, E. Zavala4, J. Bewley5, G. Marx1 and J.-L. Vincent6*
Friedrich-Schiller-University, Jena, Germany. 2Centre Hospitalier Universitaire Lariboisiere,Paris, France. 3 ´ ´ ´ Fundacion Jimenez Dıaz, Madrid, Spain. 4Hospital Clinic of Barcelona, Spain. 5Bristol Royal Inﬁrmary, 6 Bristol, UK. Erasme Hospital, Free University of Brussels, Belgium on behalf of the ‘Sepsis Occurrence in Acutely Ill Patients’ investigators
*Corresponding author: Department of Intensive Care, Erasme University Hospital, Route De Lennik 808, 1070 Brussels, Belgium. E-mail:email@example.com
Background. The inﬂuence of hydroxyethyl starch (HES) solutions on renal function is controversial. We investigated the effect of HES administration on renal function in critically ill patients enrolled in a large multicentre observational European study. Methods. All adult patients admitted to the 198 participating intensive care units (ICUs) during a 15-day period wereenrolled. Prospectively collected data included daily ﬂuid administration, urine output, sequential organ failure assessment (SOFA) score, serum creatinine levels, and the need for renal replacement therapy (RRT) during the ICU stay. Results. Of 3147 patients, 1075 (34%) received HES. Patients who received HES were older [mean (SD): 62 (SD 17) vs 60 (18) years, P¼0.022], more likely to be surgicaladmissions, had a higher incidence of haematological malignancy and heart failure, higher SAPS II [40.0 (17.0) vs 34.7 (16.9), P,0.001] and SOFA [6.2 (3.7) vs 5.0 (3.9), P,0.001] scores, and less likely to be receiving RRT (2 vs 4%, P,0.001) than those who did not receive HES. The renal SOFA score increased signiﬁcantly over the ICU stay independent of the type of ﬂuid administered. Although morepatients who received HES needed RRT than non-HES patients (11 vs 9%, P¼0.006), HES administration was not associated with an increased risk for subsequent RRT in a multivariable analysis [odds ratio (OR): 0.417, 95% conﬁdence interval (CI): 0.05 –3.27, P¼0.406]. Sepsis (OR: 2.03, 95% CI: 1.37 – 3.02, P,0.001), cardiovascular failure (OR: 6.88, 95% CI: 4.49 –10.56, P,0.001), haematological cancer (OR:2.83, 95% CI: 1.28 – 6.25, P¼0.01), and baseline renal SOFA scores.1 (P,0.01 for renal SOFA 2, 3, and 4 with renal SOFA¼0 as a reference) were all associated with a higher need for RRT. Conclusions. In this observational study, haematological cancer, the presence of sepsis, cardiovascular failure, and baseline renal function as assessed by the SOFA score were independent risk factors for thesubsequent need for RRT in the ICU. The administration of HES had no inﬂuence on renal function or the need for RRT in the ICU. Br J Anaesth 2007; 98: 216–24 Keywords: complications, renal; ﬂuids, i.v.; hydroxyethyl starch; kidney, failure Accepted for publication: May 17, 2006
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Hydroxyethyl starch (HES) solutions aresynthetic colloids with pharmacological properties that are closest to natural colloids.1 Apart from being a pure volume expander, the use of HES in the context of sepsis has been associated with a reduction in the circulating levels of adhesion
molecules,2 thus potentially reducing endothelial activation and damage. Additionally, HES may exert useful
† Declaration of interest. Supported by anunlimited grant from Abbott, Baxter, Eli Lilly, GlaxoSmithKline, and NovoNordisk. ‡ This article is accompanied by Editorial I.
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