The influence of different intravascular volume replacement regimens on renal function in the elderly.
Elderly patients are at risk of developing renal dysfunction. Synthetic colloids are often used perioperatively, but they may have detrimental effects on renal function. In a prospective, randomized study, we assessed the influence of different intravascular volume replacement regimens on renal function in elderly (>65 yr) and younger (< 65 yr) patients without preoperative renal dysfunction who were undergoing major abdominal surgery. Either 6% low molecular weight hydroxyethyl starch (HES) solution (mean molecular weight 70,000 D, degree of substitution 0.5; HES 70/0.5) [each group n = 10]), 6% medium-molecular weight HES (molecular weight 200,000 D, degree of substitution 0.5 (HES 200/0.5) [each group n = 10]), or modified gelatin (molecular weight 35,000 D [each group n = 10]) was administered to maintain mean arterial blood pressure >65 mm Hg and central venous pressure between 10 and 14 mm Hg. After the induction of anesthesia (T0); at the end of surgery (T1); 4 h after surgery (T2); and on the first (T3), second (T4), and third postoperative days (T5), alpha1-microglobulin (alpha1-M), N-acetyl-beta-glucosaminidase, fractional sodium clearance, and creatinine clearance (CC) were measured. Colloids (1300-3000 mL) were infused until the first postoperative day. At T0, urine concentrations of alpha1-M were higher in the elderly than in the younger patients in all groups (P < 0.05). alpha1-M remained increased only in the gelatin group. N-acetyl-beta-glucosaminidase and fractional sodium clearance were not affected during the study period in any groups. At baseline, CC was significantly higher in the younger than in the elderly patients, but CC did not decrease in any of the intravascular volume replacement groups. We conclude that intravascular volume therapy with gelatin and two different HES preparations did not adversely affect renal function in elderly patients without preoperative renal malfunction.


CONCLUSIONS
We studied the influence of three different intravascular volume replacement regimens on renal function in elderly patients without renal dysfunction who were undergoing major abdominal surgery. Two hydroxyethyl starch and one gelatin preparation were administered perioperatively to maintain stable hemodynamics. As assessed by sensitive markers of renal function, all three regimens can be used safely for volume replacement without risking significant renal dysfunction.
Kumle
B
B
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Germany.
Boldt
J
J
Piper
S
S
Schmidt
C
C
Suttner
S
S
Salopek
S
S
D000005:Abdomen / Q000601:surgery*; D000118:Acetylglucosaminidase / Q000032:analysis; D000368:Aged; D000510:Alpha-Globulins / Q000032:analysis; D001794:Blood Pressure; D002496:Central Venous Pressure; D003404:Creatinine / Q000032:analysis; D005260:Female; D005780:Gelatin / Q000008:administration & dosage; D006339:Heart Rate; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007668:Kidney / Q000502:physiology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011446:Prospective Studies; D012964:Sodium / Q000032:analysis
D000510:Alpha-Globulins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; C016001:alpha-1-microglobulin; D005780:Gelatin; D012964:Sodium; D003404:Creatinine; D000118:Acetylglucosaminidase