Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients.
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.
Schabinski
Franziska
F
Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University Hospital, 07743 Jena, Germany.
Oishi
Janaina
J
Tuche
Fabio
F
Luy
Alain
A
Sakr
Yasser
Y
Bredle
Donald
D
Hartog
Christiane
C
Reinhart
Konrad
K
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
D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin