Renal effects of saline-based 10% pentastarch versus 6% tetrastarch infusion in ovine endotoxemic shock.
BACKGROUND
Conflicting data exist on the renal effects of hydroxyethyl starch (HES) preparations. The current study evaluates the effects of saline-based 6% HES 130/0.4, 10% HES 200/0.5, and a balanced isotonic crystalloid on renal function and microscopic changes in ovine endotoxemic shock.


METHODS
Thirty sheep were subjected to endotoxin infusion (Salmonella typhosa) at incremental doses until mean arterial pressure was less than 65 mmHg. Animals were randomized to receive fluid resuscitation with saline-based 6% HES 130/0.4, 10% HES 200/0.5, or a balanced isotonic crystalloid (n = 10 each). Animals surviving the 12-h intervention period were anesthetized and killed. Kidney samples were taken for microscopic analyses.


RESULTS
Endotoxemia was associated with hemoconcentration, protein extravasation, and arterial hypotension. Fluid resuscitation established a hypotensive-hyperdynamic circulation with increased cardiac index and oxygen delivery and decreased afterload. Diuresis was lowest in animals treated with 10% HES 200/0.5. In addition, plasma creatinine and urea concentrations increased in sheep treated with 10% HES 200/0.5 (1.2 +/- 0.1 and 19 +/- 2 mg/dl) when compared with the other two groups (0.9 +/- 0.1 and 15 +/- 1 mg/dl, 6% HES 130/0.4; 0.9 +/- 0.1 and 15 +/- 1 mg/dl, crystalloids; each P < 0.05). Electron microscopic tubular injury score was highest in sheep treated with 10% HES 200/0.5 (P < 0.001 vs. 6% HES 130/0.4).


CONCLUSIONS
In ovine endotoxemic shock, saline-based 10% HES 200/0.5 was linked to impaired renal function and more pronounced tubular epithelial injury when compared with 6% HES 130/0.4 and balanced crystalloids.
Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany.
Christian
C
Ertmer
Gabriele
G
Köhler
Sebastian
S
Rehberg
Andrea
A
Morelli
Matthias
M
Lange
Björn
B
Ellger
Bernardo Bollen
BB
Pinto
Eva
E
Rübig
Michael
M
Erren
Lars G
LG
Fischer
Hugo
H
Van Aken
Martin
M
Westphal
D000818:Animals; D001835:Body Weight; D003404:Creatinine / Q000097:blood; D004231:Diuresis; D019446:Endotoxemia / Q000473:pathology*; D004731:Endotoxins / Q000633:toxicity; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006895:Hydroxyethyl Starch Derivatives / Q000633:toxicity*; D007668:Kidney / Q000473:pathology* / Q000648:ultrastructure; D007674:Kidney Diseases / Q000139:chemically induced* / Q000473:pathology*; D007677:Kidney Function Tests; D007684:Kidney Tubules / Q000473:pathology; D008070:Lipopolysaccharides / Q000633:toxicity; D008854:Microscopy, Electron; D046529:Microscopy, Electron, Transmission; D009997:Osmotic Pressure; D010101:Oxygen Consumption / Q000187:drug effects; D010952:Plasma Substitutes / Q000633:toxicity*; D011506:Proteins / Q000378:metabolism; D012079:Renal Circulation / Q000187:drug effects / Q000502:physiology; D012756:Sheep; D012772:Shock, Septic / Q000473:pathology*; D014508:Urea / Q000097:blood
D004731:Endotoxins; D006895:Hydroxyethyl Starch Derivatives; D008070:Lipopolysaccharides; D010952:Plasma Substitutes; D011506:Proteins; D014508:Urea; D003404:Creatinine