title: Pentastarch 10% (250 kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery.
abstract: OBJECTIVE, DESIGN AND PATIENTS: The risk of acute kidney injury (AKI) associated with hydroxyethyl starch may be limited to higher molecular weight agents. We retrospectively evaluated the risk of AKI using pentastarch 10% (250 kDa, 0.45) in a random cohort of 563 patients operated for a cardiac surgery at a university hospital.
  
  
  METHODS
  We assessed previously identified preoperative, perioperative, and postoperative risk factors, and the volume of pentastarch given until the end of the first postoperative day. We defined AKI by a 50% rise in serum creatinine within 4 days after surgery. Different propensity adjustment methods were used to further assess the selection bias.
  
  
  RESULTS
  Fifty-four (10%) patients developed AKI. Risk factors of AKI were age, female gender, preoperative creatinine clearance, hypertension, diuretic use, left ventricular ejection fraction, valvular surgery, duration of extracorporeal circulation, duration and dose of postoperative vasopressor support, and the number of red blood cells and fresh frozen plasma transfusions. Patients with AKI received 16 +/- 9 mL/kg of pentastarch as opposed to 10 +/- 7 mL/kg in controls (p < 0.001). Pentastarch remained independently predictive of AKI, with an adjusted odds ratio per mL/kg of 1.08 (95% confidence interval 1.04-1.12, p = 0.001). This risk was dose-dependent, and the optimal cutoff volume predicting AKI was 14 mL/kg. Different propensity adjustment methods were tested, and pentastarch as a risk factor of AKI was identified.
  
  
  CONCLUSIONS
  This study identified a dose-dependent risk of AKI with pentastarch following cardiac surgery, given until the end of the first postoperative day.
authors.affiliation: Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Rioux
authors.forename: Myriam
authors.initials: M
authors.lastname: Lessard
authors.forename: Bruno
authors.initials: B
authors.lastname: De Bortoli
authors.forename: Patrick
authors.initials: P
authors.lastname: Roy
authors.forename: Martin
authors.initials: M
authors.lastname: Albert
authors.forename: Colin
authors.initials: C
authors.lastname: Verdant
authors.forename: François
authors.initials: F
authors.lastname: Madore
authors.forename: Stéphan
authors.initials: S
authors.lastname: Troyanov
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D008297:Male; D010952:Plasma Substitutes / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes