title: Comparison of 6% hydroxyethyl starch and 5% albumin for volume replacement therapy in patients undergoing cystectomy (CHART): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  The use of artificial colloids is currently controversial, especially in Central Europe Several studies demonstrated a worse outcome in intensive care unit patients with the use of hydroxyethyl starch. This recently even led to a drug warning about use of hydroxyethyl starch products in patients admitted to the intensive care unit. The data on hydroxyethyl starch in non-critically ill patients are insufficient to support perioperative use.
  
  
  METHODS
  We are conducting a single-center, open-label, randomized, comparative trial with two parallel patient groups to compare human albumin 5% (test drug) with hydroxyethyl starch 6% 130/0.4 (comparator). The primary endpoint is cystatin C ratio, calculated as the ratio of the cystatin value at day 90 after surgery relative to the preoperative value. Secondary objectives are inter alia the evaluation of the influence of human albumin and hydroxyethyl starch on further laboratory chemical and clinical parameters, glycocalyx shedding, intensive care unit and hospital stay and acute kidney injury as defined by RIFLE criteria (risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage kidney disease) criteria.
  
  
  CONCLUSIONS
  There is a general lack of evidence on the relative safety and effects of hydroxyethyl starch compared with human albumin for volume replacement in a perioperative setting. Previously conducted studies of surgical patients in which researchers have compared different hydroxyethyl starch products included too few patients to properly evaluate clinical important outcomes such as renal function. In the present study in a high-risk patient population undergoing a major surgical intervention, we will determine if perioperative fluid replacement with human albumin 5% will have a long-term advantage over a third-generation hydroxyethyl starch 130/0.4 on the progression of renal dysfunction until 90 days after surgery.
  
  
  BACKGROUND
  EudraCT number 2010-018343-34. Registered on 11 January 2010.
authors: Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. tobias.kammerer@med.uni-muenchen.de.
authors: Tobias
authors: T
authors: Kammerer
authors: Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. florian.klug@med.uni-muenchen.de.
authors: Florian
authors: F
authors: Klug
authors: Department of Anesthesiology, Surgical Clinic Munich-Bogenhausen, Denninger Strasse 44, 81679, Munich, Germany. schwarz@chkmb.de.
authors: Michaela
authors: M
authors: Schwarz
authors: Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. sebastian.hilferink@med.uni-muenchen.de.
authors: Sebastian
authors: S
authors: Hilferink
authors: Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. bernhard.zwissler@med.uni-muenchen.de.
authors: Bernhard
authors: B
authors: Zwissler
authors: Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. vera.dossow@med.uni-muenchen.de.
authors: Vera
authors: V
authors: von Dossow
authors: Department of Urology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. alexander.karl@med.uni-muenchen.de.
authors: Alexander
authors: A
authors: Karl
authors: Institute of Medical Biometry and Epidemiology, Philipps University, Bunsenstrasse 3, 35037, Marburg, Germany. muellerh@staff.uni-marburg.de.
authors: Hans-Helge
authors: HH
authors: Müller
authors: Department of Anesthesiology, Hospital of the University of Munich, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. markus.rehm@med.uni-muenchen.de.
authors: Markus
authors: M
authors: Rehm
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002985:Clinical Protocols; D055316:Cystatin C / Q000378:metabolism; D015653:Cystectomy / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D005858:Germany; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D020896:Hypovolemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D012107:Research Design; D012709:Serum Albumin / Q000008:administration & dosage* / Q000009:adverse effects; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012709:Serum Albumin; D000075462:Serum Albumin, Human