Randomized clinical trial comparing the effects on renal function of hydroxyethyl starch or gelatine during aortic aneurysm surgery.
BACKGROUND
The optimal colloid for renal protection during abdominal aortic aneurysm (AAA) surgery is not known. This study compared the effects of two hydroxyethyl starch (HES) solutions and gelatine on perioperative renal function.


METHODS
Sixty-two patients undergoing AAA surgery were randomized to 6 per cent HES of molecular weight 200/0.62 kDa or 130/0.4 kDa, or 4 per cent gelatine for plasma expansion. Measurements were taken of serum urea and creatinine to mark glomerular filtration, urinary immunoglobulin G : creatinine ratio to mark glomerular membrane function and alpha(1)-microglobulin : creatinine ratio to mark tubular dysfunction before, and for 5 days after, surgery.


RESULTS
Serum urea was lower in both HES groups than the gelatine group. Serum creatinine was lower with HES 130/0.4 compared with gelatine at days 1, 2 and 5 after surgery (P = 0.020, P = 0.045 and P = 0.045 respectively). Urinary alpha(1)-microglobulin : creatinine ratio was lower with HES 200/0.62 compared with gelatine at 4 and 8 h (P < 0.050) and lower with HES 130/0.4 compared with gelatine at 4 to 24 h, and on days 4 and 5 (P < 0.050). Urinary immunoglobulin G : creatinine was lower in both HES groups compared with gelatine. There was no difference between the two starch groups.


CONCLUSIONS
Compared with gelatine, volume expansion with both types of HES during AAA surgery improved renal function and reduced renal injury.
Mahmood
A
A
Department of Vascular Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK.
Gosling
P
P
Vohra
R K
RK
D058186:Acute Kidney Injury / Q000401:mortality / Q000517:prevention & control*; D000368:Aged; D000704:Analysis of Variance; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D005260:Female; D005780:Gelatin / Q000008:administration & dosage* / Q000494:pharmacology; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
D006895:Hydroxyethyl Starch Derivatives; D014508:Urea; D005780:Gelatin; D003404:Creatinine