title: Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: comparison of a new starch preparation with gelatin.
abstract: OBJECTIVE
  There is continuing concern on the influence of hydroxethyl starch (HES) on renal function.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  Forty consecutive patients aged >70 years undergoing cardiac surgery using cardiopulmonary bypass.
  
  
  METHODS
  Either low-molecular HES (mean molecular weight: 130 kD) with low degree of substitution (0.4) (6% HES 130/0.4) (n=20) or gelatin ( n=20) was given after induction of anesthesia until the 2nd postoperative day (POD) to keep central venous pressure between 12-14 mmHg.
  
  
  RESULTS
  Creatinine clearance (CC) and fractional sodium clearance (FSC) were measured. N-acetyl-beta-D-glucosamidase, alpha-1-microglobulin, glutathione transferase-pi, and glutathione transferase-alpha were measured from urine specimens. Measurements were made after induction of anesthesia, at the end of surgery, and at the first and the second POD. More gelatin (total: 4150+/-490 ml) than HES 130/0.4 (total: 3450+/-450 ml) was infused within the study. CC and FSC were without differences between the two groups. All measured kidney-specific proteins were almost within normal range at baseline. They increased significantly after surgery, however, without significant group differences. At the 2nd POD, kidney-specific proteins had returned almost to normal values. None of the patients developed acute renal failure.
  
  
  CONCLUSIONS
  Sensitive markers of kidney dysfunction increased in our elderly patients indicating moderate alterations in kidney integrity during cardiac surgery. The two volume replacement regimens did not differ with regard to kidney integrity in elderly patients undergoing cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany. BoldtJ@gmx.net
authors.forename: Joachim
authors.initials: J
authors.lastname: Boldt
authors.forename: Thorsten
authors.initials: T
authors.lastname: Brenner
authors.forename: Andreas
authors.initials: A
authors.lastname: Lehmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Lang
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kumle
authors.forename: Christiane
authors.initials: C
authors.lastname: Werling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D005260:Female; D005780:Gelatin / Q000627:therapeutic use*; D005853:Geriatrics; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000378:metabolism / Q000517:prevention & control*; D008297:Male; D011183:Postoperative Complications
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin