title: Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients.
abstract: OBJECTIVE
  To compare the effects of predominantly hydroxyethyl starch (HES 6% 130/0.4)-based with predominantly gelatin 4%-based fluid therapy on renal function in surgical intensive care unit (ICU) patients.
  
  
  METHODS
  Before-after, retrospective, study of surgical ICU patients. All patients admitted from January to June 2005 formed the HES group, with HES 130/0.4 as the standard colloid of choice. All patients admitted from January to June 2006 formed the GEL group, with gelatin 4% as the primary colloid. Acute renal failure (ARF) was defined as new need for renal replacement therapy (RRT) or at least a two-fold increase in baseline creatinine.
  
  
  RESULTS
  There were 1383 patients in the HES group and 1528 in the GEL group; 118 and 87, in each group respectively, had severe sepsis. The incidence of ARF and ICU and hospital mortality rates were similar in the two groups. In a post-hoc multivariable analysis, cumulative doses >33 ml/kg of either HES (OR = 1.85, 95% CI: 1.01-3.41, p < 0.001) or gelatin (OR = 1.99, 95% CI: 1.05-3.79, p = 0.035) were associated with a higher risk of ARF.
  
  
  CONCLUSIONS
  The incidence of ARF was similar in patients who received predominantly HES (6% 130/.04) fluid therapy and in those who received predominantly gelatin 4%. Moderate cumulative doses of modern HES or gelatin solutions may be associated with a higher risk of ARF.
authors.affiliation: Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University Hospital, 07743 Jena, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Schabinski
authors.forename: Janaina
authors.initials: J
authors.lastname: Oishi
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuche
authors.forename: Alain
authors.initials: A
authors.lastname: Luy
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Donald
authors.initials: D
authors.lastname: Bredle
authors.forename: Christiane
authors.initials: C
authors.lastname: Hartog
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
mesh_terms: D000368:Aged; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D005780:Gelatin; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000188:drug therapy*; D012189:Retrospective Studies; D018805:Sepsis; D013030:Spain; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin