title: Intraoperative hydroxyethyl starch 70/0.5 is not related to acute kidney injury in surgical patients: retrospective cohort study.
abstract: BACKGROUND
  Although high-molecular-weight hydroxyethyl starch (HES) has been reported to cause acute kidney injury (AKI), it is not clear whether low-molecular-weight HES (6% HES 70/0.5) can be a risk for AKI or not. We hypothesized that intraoperative 6% HES 70/0.5 administration is not related to postoperative AKI.
  
  
  METHODS
  A retrospective chart review was conducted to identify adult surgical patients with intraoperative blood loss of ≥1000 mL at a university hospital. AKI was defined as >50% increase in serum creatinine from the preoperative value within 7 days after the operation according to the RIFLE (Risk, Injury, Failure, Loss, or End-stage kidney disease) criteria. We compared the incidence of AKI between patients with and without intraoperative HES administration. Multivariate logistic regression analysis and propensity score matching were also conducted to elucidate the impact of HES on postoperative AKI.
  
  
  RESULTS
  Among 14,332 surgical cases, 846 patients met the inclusion criteria. In patients given HES (a median dose of 1000 mL, n = 635), 12.9% developed AKI, compared with 16.6% (-3.7%, -1.7% to 9.1%) in patients without HES (n = 211). Multivariate logistic regression analysis showed that HES was not an independent risk factor for postoperative AKI (odds ratio: 0.76, 0.48-1.21). Using the propensity score, 179 pairs were matched. In patients with HES, 12.3% developed AKI, compared with 14.5% in patients without HES (-2.2%, -4.9% to 9.3%).
  
  
  CONCLUSIONS
  In this uncontrolled retrospective chart review, intraoperative 6% HES 70/0.5 in a low dose was not related to postoperative AKI in patients with major intraoperative blood loss. Randomized controlled trials are warranted to further evaluate the safety and efficacy of low-molecular-weight HES.
authors.affiliation: Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-19-18, NishiShinbashi, Minato-ku, Tokyo, Japan, 105-8471.
authors.forename: Arata
authors.initials: A
authors.lastname: Endo
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Uchino
authors.forename: Kennichi
authors.initials: K
authors.lastname: Iwai
authors.forename: Keita
authors.initials: K
authors.lastname: Saito
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Sanui
authors.forename: Masanori
authors.initials: M
authors.lastname: Takinami
authors.forename: Shoichi
authors.initials: S
authors.lastname: Uezono
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007564:Japan; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes