title: Effect of hydroxyethyl starch on postoperative kidney function in patients having noncardiac surgery.
abstract: BACKGROUND
  Whether intraoperative use of hydroxyethyl starch impairs kidney function remains unknown. The authors thus tested the primary hypothesis that Hextend promotes renal injury in surgical patients. Secondarily, the authors evaluated the dose-outcome relationship, in-hospital and 90-day mortality, and whether the relationship between colloid use and acute kidney injury (AKI) depends on baseline risk for AKI.
  
  
  METHODS
  The authors evaluated the data of 44,176 adults without preexisting kidney failure who had inpatient noncardiac surgery from 2005 to 2012. Patients given a combination of colloid and crystalloid were propensity matched on morphometric, and baseline characteristics to patients given only crystalloid. The primary analysis was a proportional odds logistic regression with AKI as an ordinal outcome based on the Acute Kidney Injury Network classification.
  
  
  RESULTS
  The authors matched 14,680 patients receiving colloids with 14,680 patients receiving noncolloids for a total of 29,360 patients. After controlling for potential confounding variables, the odds of developing a more serious level of AKI with Hextend was 21% (6 to 38%) greater than with crystalloid only (P = 0.001). AKI risk increased as a function of colloid volume (P < 0.001). In contrast, the relationship between colloid use and AKI did not differ on baseline AKI risk (P = 0.84). There was no association between colloid use and risk of in-hospital (P = 0.81) or 90-day (P = 0.02) mortality.
  
  
  CONCLUSIONS
  Dose-dependent renal toxicity associated with Hextend in patients having noncardiac surgery is consistent with randomized trials in critical care patients.
authors: From the Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (B.K.K., A.P., D.I.S., A.K.); Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio (N.M., J.E.D.).
authors: Babak Kateby
authors: BK
authors: Kashy
authors: Attila
authors: A
authors: Podolyak
authors: Natalya
authors: N
authors: Makarova
authors: Jarrod E
authors: JE
authors: Dalton
authors: Daniel I
authors: DI
authors: Sessler
authors: Andrea
authors: A
authors: Kurz
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007430:Intraoperative Care / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives