title: Renal effects of synthetic colloids and crystalloids in patients with severe sepsis: a prospective sequential comparison.
abstract: OBJECTIVE
  Hydroxyethyl starch 200 is associated with renal impairment in sepsis, but hydroxyethyl starch 130/0.4 and gelatin are considered to be less harmful. We hypothesized that fluid therapy with only crystalloids would decrease the incidence of acute kidney injury.
  
  
  METHODS
  Prospective sequential comparison during intensive care unit stay.
  
  
  METHODS
  Surgical intensive care unit.
  
  
  METHODS
  Patients with severe sepsis.
  
  
  METHODS
  Changes in standard fluid therapy, with predominantly 6% hydroxyethyl starch from January 2005 to June 2005, 4% gelatin from January 2006 to June 2006, and only crystalloids from September 2008 to June 2009.
  
  
  RESULTS
  Acute kidney injury was defined by the presence of at least one RIFLE class; 118 patients received hydroxyethyl starch, 87 patients received gelatin, 141 patients received only crystalloids. Baseline serum creatinine values were similar. Patients received median cumulative doses of 46 (interquartile range, 18-92) mL/kg hydroxyethyl starch and 43 (interquartile range, 18-76) mL/kg gelatin. Total median fluid amounts were 649 (interquartile range, 275-1098) mL/kg in the hydroxyethyl starch group, 525 (237-868) mL/kg in the gelatin group, and 355 (173-911) mL/kg in the crystalloid group. The difference was statistically significant for hydroxyethyl starch after adjustment for multiple testing. Mean daily fluid intake and fluid balance were higher on days 0 and 1 in the crystalloid group. Acute kidney injury occurred in 70% of patients receiving hydroxyethyl starch (adjusted p = .002) and in 68% of patients receiving gelatin (adjusted p = .025) vs. 47% patients receiving crystalloids. Need for renal replacement therapy tended to be higher in the hydroxyethyl starch group (34%; adjusted p = .086) and in the gelatin group (34%; adjusted p = .162) in comparison to the crystalloid group (20%). Intensive care unit and hospital mortality were similar in each group (hydroxyethyl starch: 35% and 43%; gelatin: 26% and 31%; crystalloids: 30% and 37%).
  
  
  CONCLUSIONS
  Fluid resuscitation with only crystalloids was equally effective, resulted in a more positive fluid balance only on the first 2 days, and was associated with a lesser incidence of acute kidney injury.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Bayer
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Bjoern
authors.initials: B
authors.lastname: Kabisch
authors.forename: Matthias
authors.initials: M
authors.lastname: Kohl
authors.forename: Niels C
authors.initials: NC
authors.lastname: Riedemann
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
authors.forename: Khosro
authors.initials: K
authors.lastname: Hekmat
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy; D005780:Gelatin / Q000627:therapeutic use*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D015994:Incidence; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D051437:Renal Insufficiency / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications / Q000628:therapy*
chemical_list: D000077324:Crystalloid Solutions; C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D005780:Gelatin