Skip to main content
SpringerLink
Log in

RETRACTED ARTICLE: Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

This article was retracted on 21 May 2011

Abstract

Objective

There is continuing concern on the influence of hydroxethyl starch (HES) on renal function.

Design

Prospective, randomized study.

Setting

University-affiliated medical center.

Patients

Forty consecutive patients aged >70 years undergoing cardiac surgery using cardiopulmonary bypass.

Interventions

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.

Measurements and results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

References

  1. Marik PE, Iglesias J, Marini B (1997) Gastric intramucosal pH changes after volume replacement with hydroxyethyl starch or crystalloid in patients undergoing elective abdominal aortic aneurysm repair. J Crit Care 12:51–55

    Article  CAS  Google Scholar 

  2. Mythen MG, Webb AR (1994) The role of gut mucosal hypoperfusion in the pathogenesis of postoperative organ dysfunction. Intensive Care Med 20:203–209

    Article  CAS  Google Scholar 

  3. Warren BB, Durieux ME (1997) Hydroxyethylstarch: safe or not? Anesth Analg 84:206–212

    Article  CAS  Google Scholar 

  4. Traylor RJ, Pearl R (1996) Crystalloid versus colloid: all colloids are not created equal. Anesth Analg 83:209–212

    Article  CAS  Google Scholar 

  5. Cittanova ML, Leblanc I, Legendre C, Mouquet C, Riou C, Coriat P (1996) Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet 348:1620–1622

    Article  CAS  Google Scholar 

  6. Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire F, Brochard L (2001) Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicenter randomised study. Lancet 357:911–916

    Article  CAS  Google Scholar 

  7. Peron S, Mouthon L, Guettier C, Brechignac S, Cohen P, Guillevin L (2001) Hydroxyethyl starch-induced renal insufficiency after plasma exchange in a patient with polymyositis and liver cirrhosis. Clin Nephrol 55:408–411

    CAS  PubMed  Google Scholar 

  8. De Labarthe A, Jacobs F, Blot F, Glotz D (2001) Acute renal failure secondary to hydroxyethylstarch administration in a surgical patient. Am J Med 111:417–418

    Article  Google Scholar 

  9. Ducke G, Briedis JH, Weaver RA (1994) Renal support in critically ill patients: low dose dopamine or low dose-dobutamine? Crit Care Med 22:1919–1925

    Article  Google Scholar 

  10. Morgera S, Woydt R, Kern H, Schmutzler M, DeJonge K, Lun A, Rohde W, Konertz W, Kow WJ, Neumayer HM (2002) Low-dose prostacyclin preserves renal function in high-risk patients after coronary bypass surgery. Crit Care Med 30:107–112

    Article  CAS  Google Scholar 

  11. Chew STH, Newman MF, White WD, Conlon PJ, Saunders AM, Strittmatter WJ, Landolfo K, Grocott HP, Stafford-Smith M (2000) Prelimary report on the association of apolipoprotein E polymorphisms, with postoperative peak serum creatinine concentrations in cardiac surgical patients. Anesthesiology 93:325–331

    Article  CAS  Google Scholar 

  12. Kulka PJ, Tryba M, Zenz M (1996) Preoperative alpha-2-adrenergic receptor agonists prevent the deterioration of renal function after cardiac surgery: results of a randomized, controlled trial. Crit Care Med 24:947–952

    Article  CAS  Google Scholar 

  13. Mangos GJ, Brown MA, Chan WY, Horton D, Trew P, Whitworth JA (1995) Acute renal failure following cardiac surgery: incidence, outcomes and risk factors. Aust N Z J Med 25:284–289

    Article  CAS  Google Scholar 

  14. Mangano CM, Diamondstone LS, Ramsay JG, Aggarwal A, Herskowitz A, Mangano DT (1998) Renal dysfunction after myocardial revascularization: risk factors, adverse outcomes, and hospital resource utilization. The Multicenter Study of Perioperative Ischemia Research Group. Ann Intern Med 128:194–203

    Article  CAS  Google Scholar 

  15. Chertow GM, Lazerus JM, Christiansen CL, Cook EF, Hammermeister KE, Grover F, Daley J (1997) Preoperative renal risk stratification. Circulation 95:878–884

    Article  CAS  Google Scholar 

  16. Lindeman RD (1992) Changes in renal function with aging: implications for treatment. Drugs Aging 2:423–431

    Article  CAS  Google Scholar 

  17. Jorres A, Kordonouri O, Schiessler A, Hess S, Farke S, Gahl GM, Muller C, Djurup R (1994) Urinary excretion of thromboxane and markers for renal injury in patients undergoing cardiopulmonary bypass. Artif Organs 18:565–569

    Article  CAS  Google Scholar 

  18. Westhuyzen J, McGiffin DC, McCarthy J, Fleming SJ (1994) Tubular nephrotoxicity after cardiac surgery utilising cardiopulmonary bypass. Clin Chim Acta 228:123–132

    Article  CAS  Google Scholar 

  19. Costa P, Ottino GM, Matani A, Pansini S, Canavese C, Passerini G, Grezzana G (1990) Low-dose dopamine during cardiopulmonary bypass in patients with renal dysfunction. J Cardithorac Anesth 4:469–473

    Article  CAS  Google Scholar 

  20. Mantur M, Kemona H, Dabrowsky M, Dabrowska J, Sobolewski S, Prokopowicz J (2000) Alpha1-microglobulin as a marker of proximal tubular damage in urinary tract infection in children. Clin Nephrol 53:283–287

    CAS  PubMed  Google Scholar 

  21. Sundberg AGM, Appelkvist EL, Bäckman L, Dallner G (1994) Quantitation of glutathione transferase-Pi in the urine by radioimmunaoassay. Nephron 66:162–169

    Article  CAS  Google Scholar 

  22. Branten AJ, Mulder TP, Peters WH, Assmann KJ, Wetzels JF (2000) Urinary excretion of gluthatione S transferases alpha and pi in patients with proteinuria: reflection of the site of tubular injury. Nephron 85:120–126

    Article  CAS  Google Scholar 

  23. Rahn KH (1991) Acute disturbances of renal function. Chest 100 [Suppl]:197S–199S

  24. Ascione R, Lloyd CT, Underwood MJ (1999) On-pump versus off-pump cronary revascularization: evaluation of renal function. Ann Thorac Surg 68:493–498

    Article  CAS  Google Scholar 

  25. Moran M, Kapsner C (1987) Acute renal failure associated with elevated plasma oncotic pressure. N Engl J Med 317:150–153

    Article  CAS  Google Scholar 

  26. Chinitz JL, Kim KE, Onesti G, Swartz C (1971) Pathophysiology and prevention of dextran-40-induced anuria. J Lab Clin Med 77:76–87

    CAS  PubMed  Google Scholar 

  27. Legendre C, Thervet E, Page B, Percheron A, Noel LH, Kreis H (1993) Hydroxyethylstarch and osmotic-nephrosis-like lesions in kidney transplantation. Lancet 342:248–249

    Article  CAS  Google Scholar 

  28. Iana A, Schwartz D (1994) Renal tubular cellular and molecular events in acute renal failure. Nephron 68:413–418

    Article  Google Scholar 

  29. Jungheinrich C, Scharf R, Wargenau M, Bepperling F, Baron JF (2002) The pharmacokinetics and tolerability of an intravenous infusion of the new hydroxyethylstarch 130/0.4 (6%, 500 ml) in mild-to-severe renal impairment. Anesth Analg 95:544–551

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063, Ludwigshafen, Germany

    Joachim Boldt, Thorsten Brenner, Andreas Lehmann, Johannes Lang & Bernhard Kumle

  2. Clinic of Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany

    Christiane Werling

Authors
  1. Joachim Boldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thorsten Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johannes Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernhard Kumle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christiane Werling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joachim Boldt.

Additional information

This article has been retracted as the IRB approval for the research was misrepresented.

An erratum to this article is available at http://dx.doi.org/10.1007/s00134-011-2217-1.

About this article

Cite this article

Boldt, J., Brenner, T., Lehmann, A. et al. RETRACTED 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. Intensive Care Med 29, 763–769 (2003). https://doi.org/10.1007/s00134-003-1702-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-1702-6

Keywords

Search

Navigation