No Differences in Renal Function between Balanced 6% Hydroxyethyl Starch (130/0.4) and 5% Albumin for Volume Replacement Therapy in Patients Undergoing Cystectomy: A Randomized Controlled Trial.

Anesthesiology

From the Departments of Anesthesiology (T.K., F.B., S.H., N.H., F.K., J.P., K.H.-K., P.C., M.R.) and Urology (A.K.), Hospital of the University of Munich, and Department of Medical Informatics, Biometry, and Epidemiology (A.C.), Ludwig-Maximilians-Universität München, Munich, Germany.

Published: January 2018

AI Article Synopsis

  • The use of artificial colloids in medical settings has decreased, particularly in critical care, but remains common in surgeries, prompting this study on their impact on kidney health.
  • One hundred urologic patients were randomly assigned to receive either albumin 5% or hydroxyethyl starch 6% during elective cystectomy, with kidney function measured through biomarkers like cystatin C before and after surgery.
  • The study found no significant differences in kidney function or injury between the two groups, suggesting both albumin and hydroxyethyl starch are comparably safe for noncritically ill patients undergoing major surgery.

Article Abstract

Background: The use of artificial colloids has declined in critical care, whereas they are still used in perioperative medicine. Little is known about the nephrotoxic potential in noncritically ill patients during routine surgery. The objective of this trial was to evaluate the influences of albumin 5% and balanced hydroxyethyl starch 6% (130/0.4) on renal function and kidney injury.

Methods: One hundred urologic patients undergoing elective cystectomy were randomly assigned for this prospective, single-blinded, controlled study with two parallel groups to receive either albumin 5% or balanced hydroxyethyl starch 6% (130/0.4) as the only perioperative colloid. The primary endpoint was the ratio of serum cystatin C between the last visit at day 90 and the first preoperative visit. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until the third postoperative day and risk, injury, failure, loss, and end-stage renal disease criteria at postoperative days 3 and 90.

Results: The median cystatin C ratio was 1.11 (interquartile range, 1.01 to 1.23) in the albumin and 1.08 (interquartile range, 1.00 to 1.20) in the hydroxyethyl starch group (median difference = 0.03; 95% CI, -0.09 to 0.08; P = 0.165). Also, there were no significant differences concerning serum cystatin C concentrations; estimated glomerular filtration rate; risk, injury, failure, loss, and end-stage renal disease criteria; and neutrophil gelatinase-associated lipocalin. Infusion requirements, transfusion rates, and perioperative hemodynamics were similar in both groups.

Conclusions: With respect to renal function and kidney injury, this study indicates that albumin 5% and balanced hydroxyethyl starch 6% have comparable safety profiles in noncritically ill patients undergoing major surgery.

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Source
http://dx.doi.org/10.1097/ALN.0000000000001927DOI Listing

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