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) (Impact Factor: 4.48). 10/2010; 14(5):R191. DOI: 10.1186/cc9308
Source: PubMed


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.

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Available from: Christian Josef Wiedermann, Apr 15, 2014
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    • "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]. "
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    • "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). "

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    • "Nevertheless, the findings of a recent single-center, sequential, observational study [41], indicating that chloride-rich fluids, including saline and albumin, were associated with increased renal injury and need for RRT in ICU patients is of interest and should inform future further trials allowing this issue to discriminate further between individual fluids than did this sequential study, which, because of its particular design, did not lend itself to incorporation into our NMA. Since the available evidence continues to indicate a lack of adverse renal effects from albumin [37], it is likely that the burden of renal injury observed by Yunos et al. was caused by other chloride-rich fluids, the use of which cannot be considered to be cost-effective if further studies confirm Yunos et al’s results. Formulations of albumin in balanced salt solutions would be needed to address directly this issue, and it is unlikely that such products will be available, or needed, for trial in the foreseeable future. "
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