Article

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: 1.05). 11/2010; 123(21):3079-83. DOI: 10.3760/cma.j.issn.0366-6999.2010.21.023
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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    • "Dans une autre étude randomisée, la procédure d'hypotension contrôlée associée à une hémodilution normovolémique réalisée avec un cristalloïde altérait plus les paramètres de fonction rénale qu'avec l'utilisation d'un HEA 130/0,4 [20]. De plus, dans une étude réalisée en transplantation rénale, au cours de laquelle les donneurs et les receveurs étaient réanimés avec un HEA 130/0,4 ou une gélatine [21], la reprise de la fonction rénale était satisfaisante dans les deux groupes, et plus rapide avec l'HEA. La recommandation est fondée avant tout sur les études de réanimation qui montrent des effets négatifs des HEA (y compris les HEA 130/0,4) sur la fonction rénale de patients présentant une fonction rénale altérée avant traitement, et qui présentent souvent un état septique. "

    Full-text · Article · Jun 2013 · Annales francaises d'anesthesie et de reanimation
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    • "Dans une autre étude randomisée, la procédure d'hypotension contrôlée associée à une hémodilution normovolémique réalisée avec un cristalloïde altérait plus les paramètres de fonction rénale qu'avec l'utilisation d'un HEA 130/0,4 [20]. De plus, dans une étude réalisée en transplantation rénale, au cours de laquelle les donneurs et les receveurs étaient réanimés avec un HEA 130/0,4 ou une gélatine [21], la reprise de la fonction rénale était satisfaisante dans les deux groupes, et plus rapide avec l'HEA. La recommandation est fondée avant tout sur les études de réanimation qui montrent des effets négatifs des HEA (y compris les HEA 130/0,4) sur la fonction rénale de patients présentant une fonction rénale altérée avant traitement, et qui présentent souvent un état septique. "

    Full-text · Article · Jun 2013 · Annales francaises d'anesthesie et de reanimation
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    • "In fact, controversial results have been reported in the literature [18,19]. In the field of renal transplant, two studies suggested a better renal tolerance with low molecular weight HES, than with high molecular weight HES or gelatins [20,21]. In patients with septic shock, a recent study suggested that even the use of low molecular weight HES was associated with renal dysfunction. "
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    ABSTRACT: The causative role of new hydroxyethyl starch (HES 130/0.4) in renal dysfunction frequency (a > 50% increase in serum creatinine or need for renal replacement therapy (RRT)) remains debated. Using the database of a multicenter study focusing on patients with severe sepsis and septic shock, the present study aimed at identifying factors associated with the occurrence of renal dysfunction. Among the 435 patients in a multicenter study of patients with severe sepsis and septic shock in 15 Southern French ICUs, 388 patients surviving after 24 hour, without a history of renal failure were included. Factors associated with renal dysfunction and RRT were isolated using a multivariate analysis with logistic regression. Renal dysfunction was reported in 117 (33%) patients. Ninety patients required RRT. Among study participants, 379 (98%) were administered fluids in the first 24 hours of management: HES 130/0.4 only (n=39), crystalloids only (n=63), or both HES 130/0.4 and crystalloids (n=276). RRT was independently associated with the need for vasopressors and the baseline value of serum creatinine in the first 24 hours. Multivariate analysis indicated that male gender, SAPS II score, being a surgical patient, lack of decrease in SOFA score during the first 24 hours, and the interventional period of the study were independently associated with renal dysfunction. Mortality increased in the presence of renal dysfunction (48% versus 24%, P<0.01). Despite being used in more than 80% of patients with severe sepsis and/or septic shock, the administration of HES 130/0.4 in the first 24 hours of management was not associated with the occurrence of renal dysfunction.
    Full-text · Article · Feb 2012 · Critical care (London, England)
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