Hyperoncotic colloids and acute kidney injury: a meta-analysis of randomized trials

Department of Internal Medicine, Central Hospital of Bolzano, Lorenz Böhler Street 5, 39100 Bolzano, Italy.
Critical care (London, England) 10/2010; 14(5):R191. DOI: 10.1186/cc9308
Source: PubMed

ABSTRACT It has been hypothesized that hyperoncotic colloids might contribute to acute kidney injury (AKI). However, the validity of this hypothesis remains unclear.
A meta-analysis was conducted of randomized controlled trials evaluating AKI after infusion of hyperoncotic albumin and hydroxyethyl starch (HES) solutions. Mortality was a secondary endpoint. Eligible trials were sought by multiple methods, and the pooled odds ratios (OR) for AKI and death and 95% confidence intervals (CI) were computed under a random effects model.
Eleven randomized trials with a total of 1220 patients were included: 7 evaluating hyperoncotic albumin and 4 hyperoncotic HES. Clinical indications were ascites, surgery, sepsis and spontaneous bacterial peritonitis. Hyperoncotic albumin decreased the odds of AKI by 76% (OR, 0.24; CI, 0.12-0.48; P < 0.0001), while hyperoncotic HES increased those odds by 92% (OR, 1.92; CI, 1.31-2.81; P = 0.0008). Parallel effects on mortality were observed, with hyperoncotic albumin reducing the odds of death by 48% (OR, 0.52; CI, 0.28-0.95; P = 0.035) and hyperoncotic HES raising those odds by 41% (OR, 1.41; CI, 1.01-1.96; P = 0.043).
This meta-analysis does not support the hypothesis that hyperoncotic colloid solutions per se injure the kidney. Renal effects appear instead to be colloid-specific, with albumin displaying renoprotection and HES showing nephrotoxicity.

Download full-text


Available from: Christian Josef Wiedermann, Apr 15, 2014
  • Source
    • "7. The type of administered fluid. A recent meta-analysis [81] of randomised trials supported the hypothesis that albumin is nephroprotective, and hydroxyethyl starch is nephrotoxic. Albumin reduces renal dysfunction and death, particularly in cirrhotic patients with spontaneous peritonitis [50]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although associated with low morbidity and mortality, cardiopulmonary bypass remains a "non-physiologic" device that carries a set of complications. Hepatic and renal impairment are associated with a poor outcome. The knowledge of pathophysiology, risk factors and therapeutic interventions can help the anaesthesiologist in preventing these complications in daily practice. The present narrative review provides an update of the literature on the effects of cardiopulmonary bypass on hepatic and renal functions, focussing on markers of hepatic and renal injuries, perioperative strategies in preserving organ function and replacement therapies. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Baillière&#x27 s Best Practice and Research in Clinical Anaesthesiology 04/2015; 29(2). DOI:10.1016/j.bpa.2015.04.001
  • Source
    • "La tonicità di preparazioni colloidali può anche variare a seconda dell'agente. Una recente meta-analisi [32] [32] (full text) ha descritto 11 studi randomizzati per un totale di 1.220 pazienti: sette valutano l'effetto dell'albumina iperoncotica e quattro degli amidi iperoncotici. L'utilizzo di albumina iperoncotica si è associata alla diminuzione di probabilità di sviluppare AKI del 76%, a differenza di quella riportata dagli amidi iperoncotici, 92% (odds ratio [OR] 1.92; CI 1,31-2,81, p =0.0008). "
    03/2015; 32(2).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Es existieren nur sehr wenige Erkenntnisse darüber, ob sich die Ergebnisqualität der Therapie des akuten Lungenversagens („acute respiratory distress syndrome“, ARDS) in den letzten Jahrzehnten verbessert hat. In einer retrospektiven Analyse wurde daher eine Kohorte von ARDS-Patienten (n = 167), die zwischen 1985 und 2005 in der Klinik für Anaesthesiologie des Klinikums der Universität München, Campus Großhadern, behandelt wurde, bezüglich primärer und sekundärer Ergebnisparameter 5 ± 1 Jahre [Mittelwert (MW) ± Standardabweichung (SD)] nach ARDS evaluiert. Innerhalb dieser 2 Jahrzehnte fanden sich keine signifikanten Veränderungen im Lebensalter (39 ± 16 Jahre), in der Erkrankungsschwere [Acute Physiology and Chronic Health Evaluation(APACHE)-II-Score: 22 ± 5 Punkte], der Letalität (37,3 %), der Beatmungsdauer (39 ± 38 Tage) und der Intensivbehandlungsdauer (47 ± 39 Tage) der untersuchten Kohorte. Die gesundheitsbezogene Lebensqualität langzeitüberlebender Patienten [“health related quality of life“ (HRQL); n = 125, Medical Outcome Study Short Term Survey (SF-36)] verbesserte sich innerhalb der 2 Dekaden bezüglich der körperlichen Funktionsfähigkeit (49,6 ± 16,5 vs. 73,4 ± 27,5; p = 0,03) und des psychischen Wohlbefindens (49,6 ± 16,5 vs. 68,6 ± 17,8; p < 0,01). Bis auf eine Steigerung dieser beiden Aspekte der erreichten HRQL hat sich die Ergebnisqualität der ARDS-Behandlung in der untersuchten Kohorte innerhalb von 20 Jahren nicht entscheidend verbessert.
    Der Anaesthesist 04/2013; 62(4). DOI:10.1007/s00101-013-2156-z · 0.74 Impact Factor
Show more