Hydroxyethyl starch and acute kidney injury in high-risk patients undergoing cardiac surgery: A prospective multicenter study

Autor: David Nagore, Angel Candela, Martina Bürge, Pablo Monedero, Eduardo Tamayo, J. Alvarez, Manuel Murie, Duminda N. Wijeysundera DN, Marc Vives, Esther Mendez, Alberto Pasqualetto, Tomas Mon, Rafael Pita, Maria Angela Varela, Carlos Esteva, Miguel Angel Pereira, Juan Sanchez, Maria Angeles Rodriguez, Alvaro Garcia, Paula Carmona, Marta López, Azucena Pajares, Rosario Vicente, Rosa Aparicio, Isabel Gragera, Enrique Calderon, Jose Miguel Marcos, Laura Gómez, Jose Maria Rodriguez, Adolfo Matilla, Ana Medina, Laura Morales, Luis Santana, Estefania Garcia, Santiago Montesinos, Pedro Muñoz, Blanca Bravo, Julian Alvarez, Verónica Blanco
Rok vydání: 2021
Předmět:
Zdroj: Journal of Clinical Anesthesia. 73:110367
ISSN: 0952-8180
Popis: Background Hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients admitted to intensive care unit (ICU) for medical indications. We conducted a cohort study to evaluate the renal safety of modern 6% HES solutions in high-risk patients having cardiac surgery. Method In this multicentre prospective cohort study, we recruited 261 consecutive patients at high-risk for developing cardiac surgery-associated AKI, based on a Cleveland score ≥ 4 points, from July to December 2017th in 14 hospitals in Spain and the United Kingdom. Multivariable logistic regression modeling and propensity-score matched-pairs analysis were used to determine the adjusted association between administration of HES and AKI. Results Of the cohort, 95 patients (36.4%) received 6% HES 130/0.4 either intraoperatively or postoperatively. Postoperative AKI occurred in 145 patients (55.5%). The unadjusted odds of AKI was significantly higher in the HES group, when compared to those not receiving HES (OR 2.22, 95% CI 1.30–3.80, p = 0.003). In multivariable logistic regression models, modern HES was not associated with significantly increased risk of AKI (adjusted OR 0.84, 95% CI 0.41–1.71, p = 0.63). In propensity score match-pairs analysis of 188 patients, the HES group experienced similar adjusted odds of AKI (OR 1.05, CI 95% 0.87–1.27, p = 0.57) and RRT (OR 1.06, CI 95% 0.92–1.22, p = 0.36). Conclusions The use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with an increased risk of AKI nor dialysis in this cohort of patients at elevated risk for developing AKI after cardiac surgery.
Databáze: OpenAIRE