Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study

Autor:	Isabelle Cattaneo, François Lemaire, Jean-Claude Lacherade, Laurent Brochard, F. Bruneel, François Hemery, Frédérique Schortgen
Rok vydání:	2001
Předmět:	Adult Male Risk medicine.medical_specialty medicine.medical_treatment Plasma Substitutes Renal function Gastroenterology Statistics Nonparametric Hydroxyethyl Starch Derivatives chemistry.chemical_compound Oliguria Sepsis Internal medicine Severity of illness medicine Humans Prospective Studies Renal replacement therapy Aged Pentastarch Creatinine business.industry Septic shock General Medicine Acute Kidney Injury Middle Aged medicine.disease Shock Septic Survival Analysis Surgery Intensive Care Units chemistry Multivariate Analysis Fluid Therapy Gelatin Female France medicine.symptom business Kidney disease
Zdroj:	The Lancet. 357:911-916
ISSN:	0140-6736
Popis:	Summary Background Hydroxyethylstarch used for volume restoration in brain-dead kidney donors has been associated with impaired kidney function in the transplant recipients. We undertook a multicentre randomised study to assess the frequency of acute renal failure (ARF) in patients with severe sepsis or septic shock treated with hydroxyethylstarch or gelatin. Methods Adults with severe sepsis or septic shock were enrolled prospectively in three intensive-care units in France. They were randomly assigned 6% hydroxyethylstarch (200 kDa, 0·60–0·66 substitution) or 3% fluid-modified gelatin. The primary endpoint was ARF (a two-fold increase in serum creatinine from baseline or need for renal replacement therapy). Analyses were by intention to treat. Findings 129 patients were enrolled over 18 months. Severity of illness and serum creatinine (median 143 [IQR 88–203] vs 114 [91–175] μmol/L) were similar at baseline in the hydroxyethylstarch and gelatin groups. The frequencies of ARF (27/65 [42%] vs 15/64 [23%], p=0·028) and oliguria (35/62 [56%] vs 23/63 [37%], p=0·025) and the peak serum creatinine concentration (225 [130–339] vs 169 [106–273] mol/L, p=0·04) were significantly higher in the hydroxyethylstarch group than in the gelatin group. In a multivariate analysis, risk factors for acute renal failure included mechanical ventilation (odds ratio 4·02 [95% CI 1·37–11·8], p=0·013) and use of hydroxyethylstarch (2·57 [1·13–5·83], p=0·026). Interpretation The use of this preparation of hydroxyethylstarch as a plasma-volume expander is an independent risk factor for ARF in patients with severe sepsis or septic shock.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::727100eeab04d114c1891f950ab7d6dd https://doi.org/10.1016/s0140-6736(00)04211-2 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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