title: Infusion of 7.2% NaCl/6% hydroxyethyl starch 200/0.5 in on-pump coronary artery bypass surgery patients: a randomized, single-blind pilot study.
abstract: BACKGROUND
  NaCl 7.2%/6% hydroxyethyl starch (HES) 200/0.5 (HSH) has shown its beneficial effects in cardiac surgery and immunomodulatory values in experiment and human studies. However, there is concern regarding detrimental renal effects of chloride and HES in the intensive care setting.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the influence of HSH on kidney integrity and the level of inflammatory mediators in on-pump coronary artery bypass surgery patients.
  
  
  METHODS
  This was a single-center, prospective, randomized, single-blind pilot study.
  
  
  METHODS
  This work was performed at a tertiary cardiothoracic referral center during the period from February to August 2012.
  
  
  METHODS
  Forty patients scheduled for on-pump coronary artery bypass surgery were included.
  
  
  METHODS
  PATIENTS were randomized to receive once either 7.2% NaCl/6% HES 200/0.5 (HSH group, n = 20) or placebo (0.9% NaCl; control group, n = 20) at a dose of 4 mL·kg for 30 min after anesthesia induction.
  
  
  METHODS
  The primary end point was the incidence of acute kidney injury (AKI) defined according to the Kidney Disease: Improving Global Outcomes. Secondary end points were peak serum cystatin C, peak urine neutrophil gelatinase-associated lipocalin, plasma levels of interleukin 6 (IL-6), IL-10, intercellular adhesion molecule 1, and endothelial-leukocyte adhesion molecule (E-selectin).
  
  
  RESULTS
  The incidence of AKI within 48 h was similar between the groups (HSH: four patients [20%]; control: six patients [30%]). There was a significantly lower peak value for serum cystatin C in the HSH group (0.83 [0.73-0.89] mg·L) compared with the control group (1.02 [0.88-1.15] mg·L; P = 0.001). PATIENTS in both groups had similar peak postoperative urine neutrophil gelatinase-associated lipocalin concentrations. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 significantly reduces levels of IL-6 and IL-10 at 4 h after cardiopulmonary bypass and intercellular adhesion molecule 1 and E-selectin at 4 h after cardiopulmonary bypass and on postoperative day 1 (P < 0.05 for all).
  
  
  CONCLUSIONS
  NaCl 7.2%/6% hydroxyethyl starch 200/0.5 does not lead to the increase in AKI incidence when used for the volume therapy in on-pump coronary artery bypass surgery patients. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 usage enhanced neither tubular injury nor alteration of glomerular filtration. In addition, HSH can reduce the level of the inflammatory mediators after surgery.
authors.affiliation: From the Department of Anaesthesiology and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Vladimir V
authors.initials: VV
authors.lastname: Lomivorotov
authors.forename: Evgeny V
authors.initials: EV
authors.lastname: Fominskiy
authors.forename: Sergey M
authors.initials: SM
authors.lastname: Efremov
authors.forename: Valeriy A
authors.initials: VA
authors.lastname: Nepomniashchikh
authors.forename: Vladimir N
authors.initials: VN
authors.lastname: Lomivorotov
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Chernyavskiy
authors.forename: Anna N
authors.initials: AN
authors.lastname: Shilova
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Karaskov
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D015994:Incidence; D018836:Inflammation Mediators / Q000097:blood*; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D018836:Inflammation Mediators; D010952:Plasma Substitutes; D012965:Sodium Chloride