Abstract
Concerns about the nephrotoxicity of tetrastarches have recently increased with the accumulation of new evidence, particularly in relationship to septic patients. Two meta-analyses in 2011 and early 2012 also raised concerns about nephrotoxicity in surgical patients and prompted the present review of the nephrotoxicity of tetrastarches solely in the surgical setting. Seven reports consisting of two review articles and five single-trial papers published between 2012 and August 2013 were examined. Six of the seven studies did not show any adverse renal outcomes following the intraoperative use of tetrastarch, although their data are not robust enough to confirm definitive safety. Moreover, balanced electrolyte solutions are strongly recommended as a carrier solution for tetrastarches to reduce adverse outcomes.
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Bayer O, Reinhart K, Kohl M, Kabisch B, Marshall J, Sakr Y, Bauer M, Hartog C, Schwarzkopf D, Riedemann N. Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: a prospective sequential analysis. Crit Care Med 2012;40:2543–51.
Hasse N, Perner A, Hennings LI, Siegemund M, Lauridsen B, Wetterslev M, Wetterslev J. Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis. BMJ. 2013;346:f839.
Mutter TC, Ruth CA, Dart AB. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function (review). Cochrane Database Syst Rev 2013;7:CD007594.
Patel A, Waheed U, Brett SJ. Randomised trials of 6% tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis. Intensive Care Med. 2013;39:811–22.
Zarychanski B, Abou-Setta AM, Tugeon AF, Houston BL, McIntyre L, Marshall JC. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation. JAMA. 2013;309:678–88.
Wiedermann CJ, Joannidis M. Mortality after hydroxyethyl starch 130/0.4 infusion: an updated meta-analysis of randomized trials. Swiss Med Wkly. 2012;142:w13656.
Gattas DJ, Dan A, Mybururgh J, Billot L, Lo S, Finfer S. Fluid resuscitation with 6% hydroxyethyl starch (130/0.4) in acutely ill patients: an updated systemic review and meta-analysis. Anesth Analg. 2012;114:159–69.
Hartog CS, Kohl M, Reinhart K. A systematic review of third-generation hydroxyethyl starch (HES 130/0.4) in resuscitation: safety not adequately addressed. Anesth Analg. 2011;112:635–45.
Calvert S, Shaw A. Perioperative acute kidney injury. Perioper Med. 2012;1:6.
Parida S, Badhe AS. Cardiac surgery-associated acute kidney injury. J Anesth. 2013;27:433–46.
Hogan JJ. The intravenous use of colloidal (gelatin) solutions in shock. JAMA. 1915;64:721–6.
Westphal M, James MFM, Kozeki-Langenecker S, Stocker R, Guidet B, Aken HV. Hydroxyethyl starches. Anesthesiology. 2009;111:187–202.
Legendre C, Thervet E, Page B, Percheron A, Noël L, Kreis H. Hydroxyethylstarch and osmotic-nephrosis-like lesions in kidney transplantation. Lancet. 1993;342:238–9.
Simon TP, Schuerholz T, Hüter L, Sasse M, Heyder F, Pfister W, Marx G. Impairment of renal function using hyperoncotic colloids in a two hit model of shock: a prospective randomized study. Crit Care. 2012;16:R16.
Der Linden Van, James M, Mythen M, Weiskoph RB. Safety of modern starches used during surgery. Anesth Analg. 2013;116:35–48.
Boussekey N, Damon R, Langlois J, Alfandari S, Devos P, Meybeck A, Chiche A, Grorges H, Leroy O. Resuscitation with low volume hydroxyethylstarch 130 kDa/0.4 is not associated with acute kidney injury. Crit Care. 2010;14:R40.
Hüter L, Simon TP, Weinmann L, Schuerholz T, Reinhart K, Wolf G, Amann KU, Marx G. Hydroxyethylstarch impairs renal function and induces interstitial proliferation, macrophage infiltration and tubular damage in an isolated renal perfusion model. Crit Care. 2009;13:R23.
Neuhaus W, Schick MA, Bruno RR, Schneiker B, Förster CY, Roewer N, Wunder C. The effects of colloid solutions on renal proximal tubular cells in vitro. Anesth Analg. 2012;114:371–4.
Silva PL, Güldner A, Uhlig C, Carvalho N, Beda A, Rentzsch I, Kasper M, Wiedemann B, Spieth PM, Koch T, Capelozi VL, Pelosi P, Rocco PRM, Gama de Abreu M. Effects of intravascular volume replacement on lung and kidney function and damage in nonseptic experimental lung injury. Anesthesiology. 2013;1138:395–408.
Ertmer C, Kampmeier TG, Rehberg S, Morelli A, Köhler G, Lange M, Bollen Pinto B, Höhn C, Hahnenkamp K, Van Aken H, Westphal M. Effects of balanced crystalloid vs. 0.9% saline-based vs. balanced 6% tetrastarch infusion on renal function and tubular integrity in ovine endotoxemic shock. Crit Care Med. 2011;39:783–92.
Perner A, Hasse N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, Madsen KR, Møller MH, Elkjær JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard AI, Fabritius MI, Mondrup F, Pott FC, Møller TP, Winkel P, Wetterslev J; 6S Trial Group; Scandinavian Critical Care Trials Group. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367:124–34.
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArther C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA; CHEST Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012; 367:1901–11.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure- definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–12.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, The Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.
Martin C, Jacob M, Vicaut E, Guidet B, Aken HV, Kurz A. Effect of waxy maize-derived hydroxyethyl starch 130/0.4 on renal function in surgical patients. Anesthesiology. 2013;118:387–94.
Feldheiser A, Pavlova V, Bonomo T, Jones A, Fotopoulou C, Sehouli J, Wemecke KD, Spies C. Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm. Br J Anaesth. 2013;110:231–40.
Gurbutz HA, Durukan AB, Salman N, Tavlasoglu M, Durukan E, Ucar HI, Yorgancioglu C. Hydroxyethyl starch 6 %, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study. J Cardiothorac Surg. 2013;8:71. doi:10.1186/1749-8090-8-71.
Van Der Linden P, De Villé A, Hofer A, Heschl M, Gombotz H. Six percent hydroxyethyl starch 130/0.4 (Voluven®) versus 5% human albumin for volume replacement therapy during elective open-heart surgery in pediatric patients. Anesthesiology 2013 (Epub ahead of print).
Akkucuk FG, Kanbak M, Ayhan B, Celebioglu B, Aypar U. The effect of HES (130/0.4) usage as the priming solution on renal function in children undergoing cardiac surgery. Ren Fail. 2013;35:210–5.
Ishikawa S, Griesdale DEG, Lohser J. Acute kidney injury after lung resection surgery: incidence and perioperative risk factors. Anesth Analg. 2012;114:1256–62.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.
Bayer O, Schwarzkopf D, Doenst T, Cook D, Kabisch B, Schelenz C, Bauer M, Riedemann N, Sakr Y, Kohl M, Reinhart K, Hartog C. Perioperative fluid therapy with tetrastarch and gelatin in cardiac surgery: a prospective sequential analysis. Crit Care Med 2013; doi:10.1097/CCM.0b013e3182978fb6.
Wijeysundera DN, Karkouti K, Dupuis JY, Rao V, Chan CT, Granton JT, Beattie WS. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA. 2007;25:1801–9.
Gheorghe C, Dadu R, Blot C, Barrantes F, Vazquez R, Berianu F, Feng Y, Feintzig I, Amoateng-Adjepong Y, Manthous CA. Hyperchloremic metabolic acidosis following resuscitation of shock. Chest. 2010;138:1521–2.
Sümpelmann R, Kretz F-J, Luntzer R, de Leeuw TG, Mixa V, Gäbler R, Eich C, Hollmann MW, Osthaus WA. Hydroxyethyl starch 130/0.42/6:1 for perioperative plasma volume replacement in 1130 children: results of an European prospective multicenter observational postauthorization safety study (PASS). Pediatr Anesth. 2012;22:371–8.
Prowle JR, Echeverri JE, Ligabo EV, Ronco C, Bellomo R. Fluid balance and acute kidney injury. Nat Rev Nephrol. 2010;6:107–15.
Reid F, Lobo DN, Williams RN, Rowlands BJ, Allison SP. (Ab)normal saline and physiological Hartman’ solution: a randomized double-blind crossover study. Clin Sci (Lond). 2003;104:17–24.
Peng Z-Y, Kellum JA. Perioperative fluids: a clear road ahead? Curr Opin Crit Care. 2013;19:353–8.
Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs. chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–72.
Marik PE, Cavallazzi R. Does the central pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41:1774–81.
Ertmer C, Kampmeier T, Van Aken H. Fluid therapy in critical illness: a special focus on indication, the use of hydroxyethyl starch and its different raw materials. Curr Opin Anesthesiol. 2013;26:253–60.
Bouchard J, Soroko SB, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL; Program to Improve Care in Acute Renal Disease (PICARD) Study Group. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76:422–7.
Phillips DP, Kaynar AM, Kellum JA, Gomez H. Crystallids vs. colloids: KO at the twelfth round? Crit Care. 2013;17:319.
Bagchi A, Eikermann M. Mashed potatoes and maize: are the starches safe? Anesthesiology. 2013;118:244–7.
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Ishihara, H. Kidney function after the intraoperative use of 6 % tetrastarches (HES 130/0.4 and 0.42). J Anesth 28, 249–256 (2014). https://doi.org/10.1007/s00540-013-1719-0
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DOI: https://doi.org/10.1007/s00540-013-1719-0