Article

Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin.

Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany.
Intensive Care Medicine (impact factor: 5.4). 06/2003; 29(5):763-9. DOI:10.1007/s00134-003-1702-6 pp.763-9
Source: PubMed

ABSTRACT There is continuing concern on the influence of hydroxethyl starch (HES) on renal function.
Prospective, randomized study.
University-affiliated medical center.
Forty consecutive patients aged >70 years undergoing cardiac surgery using cardiopulmonary bypass.
Either low-molecular HES (mean molecular weight: 130 kD) with low degree of substitution (0.4) (6% HES 130/0.4) (n=20) or gelatin ( n=20) was given after induction of anesthesia until the 2nd postoperative day (POD) to keep central venous pressure between 12-14 mmHg.
Creatinine clearance (CC) and fractional sodium clearance (FSC) were measured. N-acetyl-beta-D-glucosamidase, alpha-1-microglobulin, glutathione transferase-pi, and glutathione transferase-alpha were measured from urine specimens. Measurements were made after induction of anesthesia, at the end of surgery, and at the first and the second POD. More gelatin (total: 4150+/-490 ml) than HES 130/0.4 (total: 3450+/-450 ml) was infused within the study. CC and FSC were without differences between the two groups. All measured kidney-specific proteins were almost within normal range at baseline. They increased significantly after surgery, however, without significant group differences. At the 2nd POD, kidney-specific proteins had returned almost to normal values. None of the patients developed acute renal failure.
Sensitive markers of kidney dysfunction increased in our elderly patients indicating moderate alterations in kidney integrity during cardiac surgery. The two volume replacement regimens did not differ with regard to kidney integrity in elderly patients undergoing cardiac surgery.

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Keywords

2nd postoperative day
 
>70 years undergoing cardiac surgery
 
acute renal failure
 
cardiac surgery
 
central venous pressure
 
consecutive patients
 
Creatinine clearance
 
elderly patients
 
elderly patients undergoing cardiac surgery
 
fractional sodium clearance
 
glutathione transferase-pi
 
hydroxethyl starch
 
kidney dysfunction
 
kidney-specific proteins
 
moderate alterations
 
renal function
 
significant group differences
 
two groups
 
two volume replacement regimens
 
University-affiliated medical center
 

Joachim Boldt