Effects of the novel 6% hydroxyethyl starch 130/0.4 on renal function of recipients in living-related kidney transplantation.

Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Chinese medical journal (Impact Factor: 1.02). 11/2010; 123(21):3079-83.
Source: PubMed

ABSTRACT The optimal colloid for use during kidney transplantation is not clear. Patients undergoing living-related kidney transplantation (LRKT) were used to compare the protective effects of 6% hydroxyethyl starch 130/0.4 (HES 130/0.4) and 4% succinylated gelatine, as donor kidney procurement, ischemia time and surgical conditions are comparable. Stroke volume variation (SVV) was used to monitor intravascular volume to avoid renal allograft hypoperfusion.
Eighty patients undergoing LRKT were divided into two groups: group H received 6% HES 130/0.4 and group G received 4% succinylated gelatine. All donors and recipients received 15 - 25 ml/kg of the relevant colloid during surgery. Arterial blood pressure (ABP), heart rate (HR), central venous pressure (CVP), SVV and cardiac index (CI), electrocardiography (ECG) and SpO2 were monitored continuously. SVV was kept between 6% - 13% and mean arterial pressure at 100 - 130 mmHg. Samples of venous blood and urine were obtained 30 minutes after unclamping and on the mornings of post-operative days (POD) 1 - 4 to measure serum and urine β2-microglobulin, urine α1-microglobulin, microalbumin and N-acetyl-β-D-glucosaminidase. Blood urea nitrogen (BUN) and creatine were determined pre-operation (t(0)), 3 hours after surgery (t(1)) and on PODs 1 (t(2)), 2 (t(3)), 4 (t(4)), 7 (t(5)) and 10 (t(6)). Urine output was recorded at t(1), t(2), t(5), t(6).
Age, body weight, body surface area (BSA), operation time, urine output and the colloid volume infused were comparable between the groups and hemodynamics were stable during surgery. BUN, serum creatine, serum β2-microglobulin and urine β2-microglobulin decreased significantly after surgery in both groups relative to the baseline. BUN decreased significantly in group H compared with group G at t(1), t(2) and t(4). Urine microalbumin decreased significantly in group H on POD 4 compared with group G. Urine α1-microglobulin was not significantly different between the two groups.
Both colloids can be safely used for LRKT, but HES130/0.4 was associated with a more rapid recovery of renal function.

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    ABSTRACT: Aim: Volume replacement is important for maintenance of body functions.To achieve this goal, colloids and crystalloids can be preferred. In our study we aimed to compare the effects of HES, gelatine solutions on coagulation and renal functions in patients undergoing elective major orthopedic surgery. Material and Method: ASA I-II, 55-80years old, fifty patients scheduled under spinal anesthesia. Patients were divided into two groups.Groups HES received HES130/0.4 solution¯¹, Group GEL received same amount of %4 gelatine solution starting 30 minutes before the anaesthesia. Mesurements of hemoglobin(Hb), hematocrit (Hct), platelet, prothrombine time(PT), activated partial thromboplastin time (aPTT), %activations, international normalized ratio (INR), sodium, potassium, chlorine, blood urea nirogen(BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransaminase (AST) were examined before and at 4,12,24 hour after surgery. Creatine clearence was calculated.Hemodynamic parameters, block levels, blood losses, blood transfusion requirements and total fluid volume were recorded. Results: The demographic data,duration of operations, hemodynamic parameters,block levels,blood losses,blood transfusion requirements, (given)total fluid volume were similar. There were no difference in PT, aPTT, %activations, INR levels, sodium, potassium, ALT, AST, creatinine and creatinine clearence between the groups. In postoperative 24thhour Hb, Hct values were found lower (p=0.007, p=0.008); platelet counts were found lower at postoperative 12th,24thhour (p=0.028,p=0.007)in Group HES compared with Group GEL.BUN levels were higher in Group GEL than Group HES at 24hour after surgery(p=0.021).The chlorine levels were higher in Group HES than Group GEL at 3 postoperative 4th and 12thhour (p=0.009,p=0.046). Discussion: Although our administtered dose of HES and gelatine solutions were caused changes in different parameters, none of them needed treatment. So, we concluded that both of two colloid solution can be used safely in patients older than 55years for major surgery,providing that the patients examined strictly.
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    ABSTRACT: Background The aim of this study was to report current anaesthetic management brain-dead organ donors and to assess its impact on delayed kidney graft function (DGF).Methods To achieve this retrospective multicenter study, brain-dead patient records were analysed for the years 2005 to 2007. Expanded donor criteria, length of stay in ICU, duration of brain death, respect of recommended cold ischemia time, preoperative and intraoperative management, type of anaesthesia, hemodynamic and respiratory parameters during organ retrieval, and impact of anaesthesia on DGF were analysed.ResultsOne hundred and forty-nine out of 165 files were available. Sixty-two percent of donors received anaesthetic drugs. There were no differences in demographic characteristics between the anaesthesia group (group A) and the no-anaesthesia group (group NA). In group NA, the mean arterial pressure (MAP) > 65 mmHg was more frequent (53% vs. 29%, P < 0.01), but did not differ for maximal MAP. In group A, maximal heart rate was higher (120 vs. 105b/min, P = 0.02) and donors received significantly more colloids (P < 0.01). Independent risk factors of DGF included absence of hydroxyethyl starch infusion during the preoperative period and mechanical ventilation without PEEP.Conclusion During organ retrieval, 62% of organ donors received anaesthetic drugs. Use of anaesthesia lead to lower MAP requiring more fluid challenge with colloids but did not influence the DGF.
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