title: Lack of nephrotoxicity by 6% hydroxyethyl starch 130/0.4 during hip arthroplasty: a randomized controlled trial.
abstract: BACKGROUND
  Hydroxyethyl starch (HES) is commonly used as plasma expander during surgery but may be nephrotoxic as seen in studies in patients with sepsis. The authors hypothesized that the possible nephrotoxicity of 6% HES 130/0.4 could be revealed by measurements of urinary excretion of neutrophil gelatinase-associated lipocalin (u-NGAL) in patients with normal renal function during hip arthroplasty.
  
  
  METHODS
  In this randomized, double-blinded, placebo-controlled study, 40 patients referred for hip arthroplasty received either 6% HES 130/0.4 or isotonic saline 0.9%; 7.5 ml/kg during the first hour of surgery and 5 ml/kg during the following hours; 38 patients completed the study. U-NGAL, urine albumin, blood pressure, and plasma concentrations of creatinine, renin, NGAL, albumin, angiotensin-II, and aldosterone were measured before, during, and after surgery. U-NGAL was defined as primary outcome.
  
  
  RESULTS
  There were no significant differences in U-NGAL (mean difference and 95% CI), plasma creatinine, and urine albumin during the study. U-NGAL and urine albumin increased significantly in both groups the morning after surgery but was normalized at follow-up after 10 to 12 days. Mean arterial pressure was significantly higher during the recovery period in the HES group compared with that in the control group (91 [13] and 83 [6] mmHg, mean [SD], P < 0.03). Plasma renin and angiotensin-II were nonsignificantly different in both groups, whereas plasma aldosterone was significantly lower in the HES group. Plasma albumin was reduced in both groups, but to a significantly lower level in the HES group.
  
  
  CONCLUSIONS
  The study showed no evidence of a harmful effect of intraoperative infusion of 6% HES 130/0.4 on renal function in patients during hip arthroplasty.
authors.affiliation: From the University Clinic in Nephrology and Hypertension, Department of Medical Research and University of Aarhus, Holstebro Hospital, Holstebro, Denmark (A.S.P.K., E.B.P.); Department of Anesthesiology, Holstebro Hospital, Holstebro, Denmark (A.S.P.K., L.P., N.P.E.); and Department of Orthopedics, Holstebro Hospital, Holstebro, Denmark (T.B.H.).
authors.forename: Anne Sophie Pinholt
authors.initials: AS
authors.lastname: Kancir
authors.forename: Lina
authors.initials: L
authors.lastname: Pleckaitiene
authors.forename: Torben Bæk
authors.initials: TB
authors.lastname: Hansen
authors.forename: Niels Peter
authors.initials: NP
authors.lastname: Ekeløf
authors.forename: Erling Bjerregaard
authors.initials: EB
authors.lastname: Pedersen
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D007674:Kidney Diseases / Q000139:chemically induced*; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects*; D011518:Proto-Oncogene Proteins / Q000652:urine; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D006895:Hydroxyethyl Starch Derivatives; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D010952:Plasma Substitutes; D011518:Proto-Oncogene Proteins