title: The effect of 6% hydroxyethyl starch 130/0.4 on renal function, arterial blood pressure, and vasoactive hormones during radical prostatectomy: a randomized controlled trial.
abstract: BACKGROUND
  Although hydroxyethyl starch (HES) is commonly used as an intravascular volume expander in surgical patients, recent studies suggest that it may increase the risk of renal failure in critically ill patients. We hypothesized that patients undergoing radical prostatectomy and receiving HES would be more likely to develop markers of renal failure, such as increasing urinary neutrophil gelatinase-associated lipocalin (u-NGAL), creatinine clearance (C(crea)), and decreasing urine output (UO).
  
  
  METHODS
  In a randomized, double-blinded, placebo-controlled study, 40 patients referred for radical prostatectomy received either 6% HES 130/0.4 or saline 0.9%; 7.5 mL/kg during the first hour of surgery and 5 mL/kg in the following hours; u-NGAL, urine albumin, C(crea), UO, arterial blood pressure, and plasma concentrations of creatinine, renin, angiotensin II, aldosterone, and vasopressin were measured before, during, and after surgery.
  
  
  RESULTS
  Thirty-six patients completed the study. u-NGAL, C(crea), UO, plasma neutrophil gelatinase-associated lipocalin, p-creatinine, urine albumin, and arterial blood pressure were the same in both groups. Blood loss was higher in the HES group (HES 1250 vs saline 750 mL), while p-albumin was reduced to a significantly lower level. P-renin and p-angiotensin-II increased in both groups, whereas p-aldosterone and p-vasopressin increased significantly in the saline group.
  
  
  CONCLUSIONS
  We found no evidence of nephrotoxicity after infusion of 6% HES 130/0.4 in patients undergoing prostatectomy with normal preoperative renal function. Hemodynamic stability and infused fluid volume were the same in both groups. We observed an increased blood loss in the group given 6% HES 130/0.4.
authors: From the University Clinic for Nephrology and Hypertension, Department of Medical Research and Medicine, and Department of Anesthesiology, Holstebro Hospital and University of Aarhus, Holstebro, Denmark; Department of Urology, Holstebro Hospital, Holstebro, Denmark; Department of Anesthesiology, Holstebro Hospital, Holstebro, Denmark; and University Clinic for Nephrology and Hypertension, Department of Medical Research and Department of Medicine, Holstebro Hospital and University of Aarhus, Holstebro, Denmark.
authors: Anne Sophie Pinholt
authors: ASP
authors: Kancir
authors: Joergen Kühlwein
authors: JK
authors: Johansen
authors: Niels Peter
authors: NP
authors: Ekeloef
authors: Erling Bjerregaard
authors: EB
authors: Pedersen
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D000419:Albuminuria / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000652:urine; D000450:Aldosterone / Q000097:blood*; D000804:Angiotensin II / Q000097:blood; D062186:Arterial Pressure / Q000187:drug effects*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016063:Blood Loss, Surgical; D003404:Creatinine / Q000097:blood; D003718:Denmark; D004311:Double-Blind Method; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D011468:Prostatectomy / Q000009:adverse effects; D011518:Proto-Oncogene Proteins / Q000652:urine; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014667:Vasopressins / Q000097:blood*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D006895:Hydroxyethyl Starch Derivatives; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D010952:Plasma Substitutes; D011518:Proto-Oncogene Proteins; D014667:Vasopressins; D000804:Angiotensin II; D000450:Aldosterone; D003404:Creatinine; D012083:Renin
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